{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:40:27Z","timestamp":1784958027994,"version":"3.55.0"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"23","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,6,20]]},"abstract":"<jats:sec id=\"ab-joi230057-4\"><jats:title>Importance<\/jats:title><jats:p>Use of oral vitamin K antagonists (VKAs) may place patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke caused by large vessel occlusion at increased risk of complications.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230057-5\"><jats:title>Objective<\/jats:title><jats:p>To determine the association between recent use of a VKA and outcomes among patients selected to undergo EVT in clinical practice.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230057-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>Retrospective, observational cohort study based on the American Heart Association\u2019s Get With the Guidelines\u2013Stroke Program between October 2015 and March 2020. From 594 participating hospitals in the US, 32\u202f715 patients with acute ischemic stroke selected to undergo EVT within 6 hours of time last known to be well were included.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230057-7\"><jats:title>Exposure<\/jats:title><jats:p>VKA use within the 7 days prior to hospital arrival.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230057-8\"><jats:title>Main Outcome and Measures<\/jats:title><jats:p>The primary end point was symptomatic intracranial hemorrhage (sICH). Secondary end points included life-threatening systemic hemorrhage, another serious complication, any complications of reperfusion therapy, in-hospital mortality, and in-hospital mortality or discharge to hospice.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230057-9\"><jats:title>Results<\/jats:title><jats:p>Of 32\u202f715 patients (median age, 72 years; 50.7% female), 3087 (9.4%) had used a VKA (median international normalized ratio [INR], 1.5 [IQR, 1.2-1.9]) and 29\u202f628 had not used a VKA prior to hospital presentation. Overall, prior VKA use was not significantly associated with an increased risk of sICH (211\/3087 patients [6.8%] taking a VKA compared with 1904\/29\u202f628 patients [6.4%] not taking a VKA; adjusted odds ratio [OR], 1.12 [95% CI, 0.94-1.35]; adjusted risk difference, 0.69% [95% CI, \u22120.39% to 1.77%]). Among 830 patients taking a VKA with an INR greater than 1.7, sICH risk was significantly higher than in those not taking a VKA (8.3% vs 6.4%; adjusted OR, 1.88 [95% CI, 1.33-2.65]; adjusted risk difference, 4.03% [95% CI, 1.53%-6.53%]), while those with an INR of 1.7 or lower (n\u2009=\u20091585) had no significant difference in the risk of sICH (6.7% vs 6.4%; adjusted OR, 1.24 [95% CI, 0.87-1.76]; adjusted risk difference, 1.13% [95% CI, \u22120.79% to 3.04%]). Of 5 prespecified secondary end points, none showed a significant difference across VKA-exposed vs VKA-unexposed groups.<\/jats:p><\/jats:sec><jats:sec id=\"ab-joi230057-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Among patients with acute ischemic stroke selected to receive EVT, VKA use within the preceding 7 days was not associated with a significantly increased risk of sICH overall. However, recent VKA use with a presenting INR greater than 1.7 was associated with a significantly increased risk of sICH compared with no use of anticoagulants.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2023.8073","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T15:17:19Z","timestamp":1687274239000},"page":"2038","source":"Crossref","is-referenced-by-count":12,"title":["Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke"],"prefix":"10.1001","volume":"329","author":[{"given":"Brian","family":"Mac Grory","sequence":"first","affiliation":[{"name":"Department of Neurology, Duke University School of Medicine, Durham, North Carolina"},{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DaJuanicia N.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland A.","family":"Matsouaka","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, North Carolina"},{"name":"Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreyansh","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherylee W. 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