Role of Heparin during Endovascular Therapy for Acute Ischemic Stroke

Highlights • Patients who received heparin had significantly lower rates of hemorrhage. • Heparin-treated patients had nonsignificantly higher reperfusion rates. • Heparin use during endovascular therapy for AIS patients was found to be safe.

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Published in	Clinical neurology and neurosurgery Vol. 145; pp. 64 - 67
Main Authors	Farook, Naureen, Haussen, Diogo, Sur, Samir, Snelling, Brian, Gersey, Zachary, Yavagal, Dileep, Peterson, Eric
Format	Journal Article
Language	English
Published	Netherlands Elsevier B.V 01.06.2016 Elsevier Limited
Subjects	Acute ischemic stroke Age Aged Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - pharmacology Brain Ischemia - drug therapy Brain Ischemia - therapy Cardiovascular disease Carotid arteries Cerebral Hemorrhage - prevention & control Coronary vessels Demographics Diabetes Endovascular Procedures - methods Endovascular therapy Family medical history Female Funding Hemorrhage Heparin Heparin - administration & dosage Heparin - adverse effects Heparin - pharmacology Humans Hypertension Intraarterial therapy Logistics Male Medical imaging Middle Aged Neurology Neurosurgery NMR Nuclear magnetic resonance Stroke Stroke - drug therapy Stroke - therapy Treatment Outcome Variables heparin intraarterial therapy acute ischemic stroke endovascular therapy hemorrhage Endovascular therapy Heparin Acute ischemic stroke Hemorrhage Intraarterial therapy
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Abstract	Highlights • Patients who received heparin had significantly lower rates of hemorrhage. • Heparin-treated patients had nonsignificantly higher reperfusion rates. • Heparin use during endovascular therapy for AIS patients was found to be safe.
AbstractList	Highlights • Patients who received heparin had significantly lower rates of hemorrhage. • Heparin-treated patients had nonsignificantly higher reperfusion rates. • Heparin use during endovascular therapy for AIS patients was found to be safe. Objectives Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). Patients and methods We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Results Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days. Conclusion The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation. Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days. The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation. Objectives Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). Patients and methods We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Results Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6 plus or minus 5.0 vs. 18.1 plus or minus 4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days. Conclusion The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation. OBJECTIVESSystemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS).PATIENTS AND METHODSWe performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale).RESULTSBaseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days.CONCLUSIONThe use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation. •Patients who received heparin had significantly lower rates of hemorrhage.•Heparin-treated patients had nonsignificantly higher reperfusion rates.•Heparin use during endovascular therapy for AIS patients was found to be safe. Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78–0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01–4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0–2 at 90 days. The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation.
Author	Gersey, Zachary Peterson, Eric Haussen, Diogo Yavagal, Dileep Farook, Naureen Snelling, Brian Sur, Samir
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CitedBy_id	crossref_primary_10_1080_14656566_2022_2161362 crossref_primary_10_1016_j_clineuro_2020_106354 crossref_primary_10_1136_neurintsurg_2021_017505 crossref_primary_10_1007_s00270_020_02726_9 crossref_primary_10_1136_neurintsurg_2017_013441 crossref_primary_10_1159_000488084 crossref_primary_10_3389_fneur_2019_00299 crossref_primary_10_1016_j_jstrokecerebrovasdis_2020_105052
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Keywords	heparin intraarterial therapy acute ischemic stroke endovascular therapy hemorrhage Endovascular therapy Heparin Acute ischemic stroke Hemorrhage Intraarterial therapy
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Snippet	Highlights • Patients who received heparin had significantly lower rates of hemorrhage. • Heparin-treated patients had nonsignificantly higher reperfusion... •Patients who received heparin had significantly lower rates of hemorrhage.•Heparin-treated patients had nonsignificantly higher reperfusion rates.•Heparin use... Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during... Objectives Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit... OBJECTIVESSystemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit...
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SubjectTerms	Acute ischemic stroke Age Aged Anticoagulants Anticoagulants - administration & dosage Anticoagulants - adverse effects Anticoagulants - pharmacology Brain Ischemia - drug therapy Brain Ischemia - therapy Cardiovascular disease Carotid arteries Cerebral Hemorrhage - prevention & control Coronary vessels Demographics Diabetes Endovascular Procedures - methods Endovascular therapy Family medical history Female Funding Hemorrhage Heparin Heparin - administration & dosage Heparin - adverse effects Heparin - pharmacology Humans Hypertension Intraarterial therapy Logistics Male Medical imaging Middle Aged Neurology Neurosurgery NMR Nuclear magnetic resonance Stroke Stroke - drug therapy Stroke - therapy Treatment Outcome Variables
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Title	Role of Heparin during Endovascular Therapy for Acute Ischemic Stroke
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