Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase

Solène Hebert, Pierre Clavel, Benjamin Maier, Katsuhiro Mizutani, François Delvoye, Bertrand Lapergue, Malek Ben Maacha, Robert Fahed, Simon Escalard, Jean Philippe Desilles, Hocine Redjem, Gabriele Ciccio, Stanislas Smajda, Raphael Blanc, Michel Piotin, Mikael Mazighi

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Backround and Purpose: Role of peri-procedural heparin as an adjuvant treatment during mechanical thrombectomy (MT) for patients contra-indicated for alteplase remains a source of debate. Methods: We included patients from the multicenter French register ETIS that underwent MT without administration of alteplase, and compared patients who received heparin during MT with patients who did not. Heparin impact on outcome were analyzed regarding final TICI score, NIHSS at day one, modified rankin scale (mRS) and intracranial hemorrhagic transformation on imaging at day one. Results: Over 1031 patients, 751 were included between January 2015 and June 2018 in 6 different centers, and 223 (26.69%) received heparin. Heparin administration was associated with a significant deleterious effect on NIHSS at 24h [adjusted OR = 1.2; p = 0.02], mRS at 3 months [adjusted OR 1.58; p = 0.03], and on complete reperfusion [TICI 3 adjusted OR 0.68; p = 0.02]. Heparin administration was associated with a significant reduction of hemorrhagic transformation [adjusted OR 0.48; p = 0.00005]. Conclusions: Heparin administration during MT seems deleterious for reperfusion and functional outcome. Randomized trials are needed to identify the role of antithrombotic treatments, such as heparin, in the setting of acute ischemic stroke management.

Original languageEnglish
Article number105052
JournalJournal of Stroke and Cerebrovascular Diseases
Volume29
Issue number10
DOIs
Publication statusPublished - 2020 Oct
Externally publishedYes

Keywords

  • Antithrombotic
  • Endovascular treatment
  • Heparin
  • Mechanical thrombectomy
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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