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Purpose <p>Direct oral anticoagulants (DOACs) have equivalent efficacy and fewer complications than vitamin K antagonists (VKAs) and are widely used for atrial fibrillation. However, data on how DOACs affect mechanical thrombectomy (MT) and influence the occlusion site are limited. This study aimed to investigate the efficacy and safety of MT before DOAC administration and how DOAC influences the occlusion site eligible for MT.</p> Methods <p>The NeuroEndovascular and Management from Multicenter Observation to Build a PHILosophical Approach (NEMMOPHILA) study analyzed 331 patients treated between January 2015 and March 2019 who underwent MT. The primary outcome was modified Rankin scale (mRS) of 0–3 at discharge, and the secondary outcomes included in-hospital mortality, and parenchymal hemorrhage (PH).</p> Result <p> Of the 331 patients, 39 had prior DOAC therapy, 25 had prior VKA therapy, and 267 had non- anticoagulant therapy (non-AC). The internal carotid artery (ICA) occlusion rate was significantly lower in the DOAC group (DOAC, 25.6%; VKA, 56.0%; non-AC, 45.3%; p = 0.030). No significant difference was found in the mRS at discharge (DOAC, 51.3%; VKA, 36.0%; non-AC, 50.9%; p = 0.354), mortality (DOAC, 7.5%; VKA, 7.9%; non-AC, 10.9%; p = 0.66), and PH (DOAC, 2.6%; VKA, 12.0%; non-AC, 9.0%; p = 0.362). Multiple regression analysis revealed that DOAC significantly reduced ICA occlusion (odds ratio, 0.429; 95% confidence interval, 0.195–0.943; p = 0.035).</p> Conclusion <p>Patients with prior DOAC had low ICA occlusion rates. DOAC administration history did notlead to mRS improvement at discharge and did not increase PH after MT.</p>

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Association Between Direct Oral Anticoagulants and the Risk of Internal Carotid Artery Occlusion in Patients Eligible for Thrombectomy

  • 期刊论文

  • 发表日期：

    2025年10月27日

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  • Sho Hanai,
  • Masayuki Sato,
  • Mikito Hayakawa,
  • Hisayuki Hosoo,
  • Go Ikeda,
  • Yoshiro Ito,
  • Aiki Marushima,
  • Tomoji Takigawa,
  • Wataro Tsuruta,
  • Noriyuki Kato,
  • Kazuya Uemura,
  • Kensuke Suzuki,
  • Yoji Komatsu,
  • Hiroshi Yamagami,
  • Eiichi Ishikawa,
  • Yuji Matsumaru

摘要

Purpose

Direct oral anticoagulants (DOACs) have equivalent efficacy and fewer complications than vitamin K antagonists (VKAs) and are widely used for atrial fibrillation. However, data on how DOACs affect mechanical thrombectomy (MT) and influence the occlusion site are limited. This study aimed to investigate the efficacy and safety of MT before DOAC administration and how DOAC influences the occlusion site eligible for MT.

Methods

The NeuroEndovascular and Management from Multicenter Observation to Build a PHILosophical Approach (NEMMOPHILA) study analyzed 331 patients treated between January 2015 and March 2019 who underwent MT. The primary outcome was modified Rankin scale (mRS) of 0–3 at discharge, and the secondary outcomes included in-hospital mortality, and parenchymal hemorrhage (PH).

Result

Of the 331 patients, 39 had prior DOAC therapy, 25 had prior VKA therapy, and 267 had non- anticoagulant therapy (non-AC). The internal carotid artery (ICA) occlusion rate was significantly lower in the DOAC group (DOAC, 25.6%; VKA, 56.0%; non-AC, 45.3%; p = 0.030). No significant difference was found in the mRS at discharge (DOAC, 51.3%; VKA, 36.0%; non-AC, 50.9%; p = 0.354), mortality (DOAC, 7.5%; VKA, 7.9%; non-AC, 10.9%; p = 0.66), and PH (DOAC, 2.6%; VKA, 12.0%; non-AC, 9.0%; p = 0.362). Multiple regression analysis revealed that DOAC significantly reduced ICA occlusion (odds ratio, 0.429; 95% confidence interval, 0.195–0.943; p = 0.035).

Conclusion

Patients with prior DOAC had low ICA occlusion rates. DOAC administration history did notlead to mRS improvement at discharge and did not increase PH after MT.