Safety and Outcome of Intravenous Thrombolysis in Stroke
Patients on Prophylactic Doses of Low Molecular Weight Heparins
at Stroke Onset

J 2019

Safety and Outcome of Intravenous Thrombolysis in Stroke Patients on Prophylactic Doses of Low Molecular Weight Heparins at Stroke Onset

COORAY, Charith, Michael MAZYA, Robert MIKULÍK, Lubomir JURAK, Miroslav BROZMAN et. al.

Basic information

Original name

Safety and Outcome of Intravenous Thrombolysis in Stroke Patients on Prophylactic Doses of Low Molecular Weight Heparins at Stroke Onset

Authors

COORAY, Charith (752 Sweden, guarantor), Michael MAZYA (752 Sweden), Robert MIKULÍK (203 Czech Republic, belonging to the institution), Lubomir JURAK (203 Czech Republic), Miroslav BROZMAN (703 Slovakia), Peter RINGLEB (276 Germany), Anand DIXIT (826 United Kingdom of Great Britain and Northern Ireland), Danilo TONI (380 Italy) and Niaz AHMED (752 Sweden)

Edition

Stroke, Dallas, Lippincott Williams & Wilkins, 2019, 0039-2499

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30103 Neurosciences

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 7.190

RIV identification code

RIV/00216224:14110/19:00112522

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1161/STROKEAHA.118.024575

UT WoS

000469350000039

Keywords in English

cerebral hemorrhage; comorbidities; hematoma; heparin; thrombosis

Abstract

V originále

Background and Purpose-There are limited data on intravenous thrombolysis treatment in patients with ischemic stroke who have received prophylactic doses of low molecular weight heparins (LMWHs). We aimed to evaluate the safety and outcomes of intravenous thrombolysis treatment in stroke patients taking thromboprophylactic doses of LMWH. Methods-We analyzed 109291patients treated with intravenous thrombolysis, recorded in the Safe Implementation of Treatments in Stroke International Thrombolysis Register between 2003 and 2017 not taking oral anticoagulants or therapeutic doses of heparin at stroke onset. One thousand four hundred eleven patients (1.3%) were on prophylactic LMWH for deep venous thrombosis prevention. Outcome measures were symptomatic intracerebral hemorrhage, parenchymal hematoma, death within 7 days and 3 months, and functional dependency at 3 months. Results-Patients on LMWH were older, had more severe strokes, more prestroke disability, and comorbidities than patients without LMWH. There was no significant increase in adjusted odds ratios (aOR) for symptomatic intracerebral hemorrhage (aOR, 1.02 [95% CI, 0.48-2.17] as per Safe Implementation of Treatments in Stroke -MOST, aOR, 0.95 [0.59-1.53] per ECASS II]), nor for 7-day mortality (aOR, 1.14 [0.82-1.59]), in the prophylactic LMWH group. The LMWH group had a higher aOR for 3-month mortality (aOR, 1.94 [1.49-2.53]) and functional dependency, aOR, 1.44 (1.10-1.90). Propensity score analysis matching patients on baseline characteristics removed differences between groups on all outcomes except 3-month mortality. Conclusions-Intravenous thrombolysis in patients with acute ischemic stroke on treatment with prophylactic doses of LMWH at stroke onset is not associated with an increased risk of symptomatic intracerebral hemorrhage or early death.

Links

LM2015090, research and development project

Name: Český národní uzel Evropské sítě infrastruktur klinického výzkumu (Acronym: CZECRIN)

Investor: Ministry of Education, Youth and Sports of the CR

Citovat

COORAY, Charith, Michael MAZYA, Robert MIKULÍK, Lubomir JURAK, Miroslav BROZMAN, Peter RINGLEB, Anand DIXIT, Danilo TONI and Niaz AHMED. Safety and Outcome of Intravenous Thrombolysis in Stroke Patients on Prophylactic Doses of Low Molecular Weight Heparins at Stroke Onset. Stroke. Dallas: Lippincott Williams & Wilkins, 2019, vol. 50, No 5, p. 1149-1155. ISSN 0039-2499. Available from: https://dx.doi.org/10.1161/STROKEAHA.118.024575.

@article{1605657,
   author = {Cooray, Charith and Mazya, Michael and Mikulík, Robert and Jurak, Lubomir and Brozman, Miroslav and Ringleb, Peter and Dixit, Anand and Toni, Danilo and Ahmed, Niaz},
   article_location = {Dallas},
   article_number = {5},
   doi = {http://dx.doi.org/10.1161/STROKEAHA.118.024575},
   keywords = {cerebral hemorrhage; comorbidities; hematoma; heparin; thrombosis},
   language = {eng},
   issn = {0039-2499},
   journal = {Stroke},
   title = {Safety and Outcome of Intravenous Thrombolysis in Stroke Patients on Prophylactic Doses of Low Molecular Weight Heparins at Stroke Onset},
   url = {http://dx.doi.org/10.1161/STROKEAHA.118.024575},
   volume = {50},
   year = {2019}
}

TY  - JOUR
ID  - 1605657
AU  - Cooray, Charith - Mazya, Michael - Mikulík, Robert - Jurak, Lubomir - Brozman, Miroslav - Ringleb, Peter - Dixit, Anand - Toni, Danilo - Ahmed, Niaz
PY  - 2019
TI  - Safety and Outcome of Intravenous Thrombolysis in Stroke Patients on Prophylactic Doses of Low Molecular Weight Heparins at Stroke Onset
JF  - Stroke
VL  - 50
IS  - 5
SP  - 1149-1155
EP  - 1149-1155
PB  - Lippincott Williams & Wilkins
SN  - 00392499
KW  - cerebral hemorrhage
KW  - comorbidities
KW  - hematoma
KW  - heparin
KW  - thrombosis
UR  - http://dx.doi.org/10.1161/STROKEAHA.118.024575
L2  - http://dx.doi.org/10.1161/STROKEAHA.118.024575
N2  - Background and Purpose-There are limited data on intravenous thrombolysis treatment in patients with ischemic stroke who have received prophylactic doses of low molecular weight heparins (LMWHs). We aimed to evaluate the safety and outcomes of intravenous thrombolysis treatment in stroke patients taking thromboprophylactic doses of LMWH. Methods-We analyzed 109291patients treated with intravenous thrombolysis, recorded in the Safe Implementation of Treatments in Stroke International Thrombolysis Register between 2003 and 2017 not taking oral anticoagulants or therapeutic doses of heparin at stroke onset. One thousand four hundred eleven patients (1.3%) were on prophylactic LMWH for deep venous thrombosis prevention. Outcome measures were symptomatic intracerebral hemorrhage, parenchymal hematoma, death within 7 days and 3 months, and functional dependency at 3 months. Results-Patients on LMWH were older, had more severe strokes, more prestroke disability, and comorbidities than patients without LMWH. There was no significant increase in adjusted odds ratios (aOR) for symptomatic intracerebral hemorrhage (aOR, 1.02 [95% CI, 0.48-2.17] as per Safe Implementation of Treatments in Stroke -MOST, aOR, 0.95 [0.59-1.53] per ECASS II]), nor for 7-day mortality (aOR, 1.14 [0.82-1.59]), in the prophylactic LMWH group. The LMWH group had a higher aOR for 3-month mortality (aOR, 1.94 [1.49-2.53]) and functional dependency, aOR, 1.44 (1.10-1.90). Propensity score analysis matching patients on baseline characteristics removed differences between groups on all outcomes except 3-month mortality. Conclusions-Intravenous thrombolysis in patients with acute ischemic stroke on treatment with prophylactic doses of LMWH at stroke onset is not associated with an increased risk of symptomatic intracerebral hemorrhage or early death.
ER  -

COORAY, Charith, Michael MAZYA, Robert MIKULÍK, Lubomir JURAK, Miroslav BROZMAN, Peter RINGLEB, Anand DIXIT, Danilo TONI and Niaz AHMED. Safety and Outcome of Intravenous Thrombolysis in Stroke Patients on Prophylactic Doses of Low Molecular Weight Heparins at Stroke Onset. \textit{Stroke}. Dallas: Lippincott Williams \&{} Wilkins, 2019, vol.~50, No~5, p.~1149-1155. ISSN~0039-2499. Available from: https://dx.doi.org/10.1161/STROKEAHA.118.024575.

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