Vitamin K antagonists do not increase symptomatic intracranial hemorrhage in ischemic stroke patients

A new study published in the Journal of American Medical Association shows that the use of vitamin K antagonist (VKA) within the previous seven days was not substantially linked to an elevated risk of symptomatic intracranial hemorrhage (sICH) overall among individuals with acute ischemic stroke who were chosen to receive endovascular thrombectomy (EVT).

The use of oral vitamin K antagonists (VKAs) may increase the risk of problems for patients having endovascular thrombectomy for acute ischemic stroke brought on by major artery blockage. In order to ascertain the relationship between recent usage of a VKA and results among patients chosen to undergo EVT in clinical practice, Brian Mac Grory and colleagues undertook this study.

Between October 2015 and March 2020, a retrospective, observational cohort research was conducted based on the American Heart Association's Get With the Guidelines-Stroke Program. 32 715 individuals with acute ischemic stroke who were chosen to have EVT within six hours of the time they were last known to be healthy were included from the 594 participating institutions in the US. The major criterion for this investigation was VKA usage during the seven days previous to admission to the hospital. Intracranial haemorrhage symptoms were the main end goal. Secondary endpoints were in-hospital mortality, in-hospital mortality or discharge to hospice, life-threatening systemic haemorrhage, another significant complication, any complications of reperfusion treatment, and in-hospital death.

The key findings of this study were:

3087 (9.4%) of the 32 715 patients had used a VKA before hospital admission, whereas 29 628 had not.

Overall, there was no evidence linking past VKA usage to a higher risk of sICH.

While there was no significant difference in the risk of sICH among patients with an INR of 1.7 or lower (n = 1585) compared to those on a VKA, those with an INR of 1.7 or higher had a substantially increased risk of sICH.

No one of the five predetermined secondary end goals distinguished between the VKA-exposed and VKA-unexposed groups significantly.

Recent VKA usage over the previous 7 days was not significantly related with an elevated risk of sICH overall among patients with acute ischemic stroke who were chosen to receive EVT.

Reference:

Mac Grory, B., Holmes, D. N., Matsouaka, R. A., Shah, S., Chang, C. W. J., Rison, R., Jindal, J., Holmstedt, C., Logan, W. R., Corral, C., Mackey, J. S., Gee, J. R., Dissin, J., Pandey, H., Wang, D., … Xian, Y. (2023). Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2023.8073