Heparin during endovascular stroke treatment seems safe Heparin during endovascular stroke treatment does not ameliorate clinical outcome and is associated with lower chance of reperfusion

Publication date: Available online 14 February 2019

Source: Journal of Neuroradiology

Author(s): Fabrizio Sallustio, Caterina Motta, Stefano Merolla, Giacomo Koch, Francesco Mori, Fana Alemseged, Daniele Morosetti, Valerio Ros Da, Roberto Gandini, Marina Diomedi

ABSTRACT

Background and purpose: the effect of intravenous heparin during mechanical thrombectomy for acute ischemic stroke is not clear. We aimed to study efficacy and safety of heparin use during endovascular stroke treatment in a real-world setting.

Materials and Methods: patients with anterior circulation stroke were divided, based on the use of intraprocedural heparin, in those treated and those untreated. Main outcomes were successful reperfusion defined as a TICI score ≥ 2b, 3-month functional independence defined as a modified Rankin Scale ≤ 2, symptomatic intracranial hemorrhage (sICH) and mortality.

Results: 361 patients were eligible for analysis; 200 were (H+) and 161 (H-). The (H-) group showed higher age and ASPECTS (74 ± 14 vs 68.9 ± 12.2; p = 0.001; 8 ± 1.6 vs 7.4 ± 2.1; p = 0.009) without differences in vascular risk factors. Heparin untreated patients showed a shorter onset-to-reperfusion time (271 ± 57.6 min vs 309 ± 102.2 min; p < 0.001). No differences were found in 3-month functional independence, sICH and mortality whereas the rate of successful reperfusion was higher in the (H-) group. After logistic regression analysis successful reperfusion was independently associated with CT ASPECTS (OR: 1.16; 95%CI 1.01-1.35; p = 0.040) but inversely associated with the use of heparin (OR:0.48; 95% CI 0.24-0.98; p = 0.045).

Conclusions: heparin use during mechanical thrombectomy for anterior circulation acute ischemic stroke in a realworld setting is safe.

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