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Jan C. Purrucker,Kirsten Haas,Marcel Wolf,Timolaos Rizos,Shujah Khan,Peter Kraft,Sven Poli,Rainer Dziewas,Johannes Meyne,Frederick Palm,Sebastian Jander,Markus Möhlenbruch,Peter U. Heuschmann,Roland V 대한뇌졸중학회 2017 Journal of stroke Vol.19 No.1
Background and Purpose To evaluate the frequency and outcome of haemorrhagic transformation (HT) after ischaemic stroke in patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods Patients with stroke on treatment with a NOAC were prospectively enrolled in this multicentre observational study between February 2012 and 2015. Brain imaging at admission and follow-up imaging until day 7 were reviewed for HT. Functional outcome was assessed by the modified Rankin scale (mRS) before the index event, at discharge, and at 3-months. Results 231 patients without recanalisation therapy (no-RT), and 32 patients with RT were eligible for analysis. Any HT was present at admission in 9/231 no-RT patients (3.9%, 95% CI 2.0 to 7.3) and in none of the patients with RT. In patients with follow-up imaging (no-RT, n=129, and RT, n=32), HT was present in 14.0% (no-RT; 95% CI, 8.9 to 21.1), and 40.6% (RT, 95% CI, 25.5 to 57.8), respectively. After adjustment for stroke severity, this difference between the no-RT and RT groups became non-significant. Symptomatic ICH was observed in 1 patient per group. HT was not associated with unfavourable outcome (mRS 3-6) at 3-months in multivariable analysis. Resumption of OAC after stroke was delayed in patients with HT compared to those without (15 d [IQR, 5–26] vs. 1 d [0–4], P<0.001). Conclusions The frequency and severity of HT after stroke on NOAC appears similar to previous reports for vitamin K antagonists and no anticoagulation. Whether asymptomatic HT should delay resumption of preventive anticoagulation requires further investigation.
Postthrombolysis hemorrhage risk is affected by stroke assessment bias between hemispheres
Audebert, H. J.,Singer, O. C.,Gotzler, B.,Vatankhah, B.,Boy, S.,Fiehler, J.,Lansberg, M. G.,Albers, G. W.,Kastrup, A.,Rovira, A.,Gass, A.,Rosso, C.,Derex, L.,Kim, J. S.,Heuschmann, P. Ovid Technologies (Wolters Kluwer) - American Acad 2011 Clinical Neurophysiology Vol.76 No.7