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Safety and outcome after thrombolytic treatment in ischemic stroke patients with high-risk cardioembolic sources and prior subtherapeutic warfarin use

 Young Dae Kim  ;  Jung Hwan Lee  ;  Yo Han Jung  ;  Hye Yeon Choi  ;  Chung Mo Nam  ;  Jae Hoon Yang  ;  Han Jin Cho  ;  Hyo Suk Nam  ;  Kyung-Yul Lee  ;  Ji Hoe Heo 
 JOURNAL OF THE NEUROLOGICAL SCIENCES, Vol.298(1-2) : 101-105, 2010 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Aging ; Anticoagulants/therapeutic use* ; Brain Ischemia/drug therapy* ; Carotid Artery Thrombosis/complications ; Cerebral Angiography ; Cerebral Hemorrhage/chemically induced ; Cerebral Hemorrhage/epidemiology ; Embolism/physiopathology* ; Female ; Fibrinolytic Agents/administration & dosage ; Fibrinolytic Agents/adverse effects* ; Fibrinolytic Agents/therapeutic use* ; Heart/physiopathology* ; Humans ; International Normalized Ratio ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Sex Characteristics ; Stroke/drug therapy* ; Tomography, X-Ray Computed ; Treatment Outcome ; Warfarin/therapeutic use*
Anticoagulation ; Atrial fibrillation ; Stroke ; Thrombolysis
BACKGROUND: Hemorrhage is a major complication of thrombolytic treatment. Concerns have been raised about the risk of hemorrhage in patients having received warfarin. Therefore, different indications for thrombolytic treatment are in use for stroke patients on warfarin. However, it remains uncertain whether the prior warfarin use actually increases their risk of bleeding in patients treated with thrombolysis. METHODS: This study included 179 consecutive patients who had high-risk cardioembolic sources and received thrombolytic treatment. Patients were treated with intravenous thrombolytic agents, or underwent intraarterial thrombolysis if their international normalized ratio (INR) was ≤1.7. We compared the frequency of bleeding complications between patients with prior warfarin use and those without. We also investigated whether there were differences in functional outcome and recanalization rates between them. RESULTS: A prior warfarin use was present in 28 patients (15.6%). Although INR levels were higher in the prior warfarin group, the frequency of bleeding complications was not different between patients who received prior warfarin and those who did not. No differences were observed in patients with or without prior warfarin use, for successful recanalization rate (Thrombolysis in Myocardial Infarction grade 2 or 3), mortality, or modified Rankin score (≤2) at 3months. CONCLUSIONS: Thrombolytic therapy for patients who previously received warfarin and had an INR≤1.7 did not affect bleeding risk, clinical outcome, or recanalization rate. Our data suggest that patients with a history of prior warfarin use may be safely treated with thrombolytic agents when their INR levels are low.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Jung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Yang, Jae Hoon(양재훈)
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Jung, Yo Han(정요한)
Cho, Han Jin(조한진)
Choi, Hye Yoen(최혜연)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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