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- Seiffge, D. J., et al.
(författare)
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Recanalization Therapies in Acute Ischemic Stroke Patients Impact of Prior Treatment With Novel Oral Anticoagulants on Bleeding Complications and Outcome A Pilot Study
- 2015
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 132:13, s. 1261-1269
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Tidskriftsartikel (refereegranskat)abstract
- Background-We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results-This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICH any), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICH ECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICH NINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8-22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1-1.6). ICH any was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICH ECASS-II and sICH NINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions-IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.
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| 2. |
- Palin, Laurianne, et al.
(författare)
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Three-dimensional current systems and ionospheric effects associated with small dipolarization fronts
- 2015
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Ingår i: Journal of Geophysical Research - Space Physics. - 2169-9380 .- 2169-9402. ; 120:5, s. 3739-3757
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Tidskriftsartikel (refereegranskat)abstract
- We present a case study of eight successive plasma sheet (PS) activations (usually referred to as bursty bulk flows or dipolarization fronts), associated with small individual B-ZGSM increases on 31 March 2009 (0200-0900 UT), observed by the Time History of Events and Macroscale Interactions During Substorms mission. This series of events happens during very quiet solar wind conditions, over a period of 7 h preceding a substorm onset at 1230 UT. The amplitude of the dipolarizations increases with time. The low-amplitude dipolarization fronts are associated with few (1 or 2) rapid flux transport events (RFT, E-h > 2 mV/m), whereas the large-amplitude ones encompass many more RFT events. All PS activations are associated with small and localized substorm current wedge (SCW)-like current system signatures, which seems to be the consequence of RFT arrival in the near tail. The associated ground magnetic perturbations affect a larger part of the contracted auroral oval when, in the magnetotail, more RFT are embedded in PS activations (> 5). Dipolarization fronts with very low amplitude, a type usually not included in statistical studies, are of particular interest because we found even those to be associated with clear small SCW-like current system and particle injections at geosynchronous orbit. This exceptional data set highlights the role of flow bursts in the magnetotail and leads to the conclusion that we may be observing the smallest form of a substorm or rather its smallest element. This study also highlights the gradual evolution of the ionospheric current disturbance as the plasma sheet is observed to heat up.
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