Original ArticleSafety of Periprocedural Heparin in Acute Ischemic Stroke Endovascular Therapy: The Multi MERCI Trial
Section snippets
Patients and Techniques
All patients enrolled in the Multi MERCI trial for whom data were available on the use or nonuse of periprocedural heparin were eligible for this post hoc analysis; details of the Multi MERCI trial have been previously described.6 For patients enrolled before February 1, 2006, case report forms did not collect any data on periprocedural heparin use. Therefore, the analysis cohort only included patients enrolled sequentially between February 1 and July 31, 2006 when case report forms included
Results
The analysis cohort included 51 patients who had documentation of periprocedural heparin use (n = 24) or nonuse (n = 27); the median dose of periprocedural heparin was 3000 IU (Fig 1). Comparison of the analysis cohort with those excluded because of the lack of data on periprocedural heparin use or nonuse revealed that those excluded had similar baseline characteristics but were younger than the analysis cohort (mean age 66.2 v 72.2 years; P = .02; data not shown). Comparisons of baseline and
Discussion
In this small subgroup of the Multi MERCI trial, a low-dose periprocedural heparin regimen in AIS endovascular therapy was not associated with increased rates of intracerebral hemorrhage or 90-day mortality. The improved 90-day good outcome among patients undergoing mechanical thrombectomy combined with periprocedural heparin suggests a possible benefit and warrants additional study in a larger cohort.
Since the development of percutaneous coronary intervention, IV unfractionated heparin has
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Cited by (39)
Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients
2023, Anaesthesia Critical Care and Pain MedicineEndovascular therapy for acute ischemic stroke: The importance of blood pressure control, sedation modality and anti-thrombotic management to improve functional outcomes
2022, Revue NeurologiqueCitation Excerpt :Usually, it consists in a bolus of IV UFH, between 2000 and 5000 UI. Two post-hoc analyses of RCT showed that heparin use was not associated with sICH (8 vs. 11%; OR = 0.73; [95%CI, 0.11–4.77] [76], and 12 vs. 4%; OR = 3.02; [95%CI, 0.91–9.97], [77]), or with mortality (OR = 0.73; [95%CI, 0.23–2.28],[76] and OR = 1.08; [95%CI, 0.54–2.16], [77]). Moreover, after adjustment for several prognostic factors, peri-procedural heparin use was positively associated with functional independence in both studies (aOR = 5.89; [95%CI, 1.34–25.92] [76], and aOR = 5.30; [95%CI, 1.70–16.48] [77]).
Benefits and Safety of Periprocedural Heparin During Thrombectomy in Patients Contra-Indicated for Alteplase
2020, Journal of Stroke and Cerebrovascular DiseasesHeparin during endovascular stroke treatment seems safe
2019, Journal of NeuroradiologyCitation Excerpt :With the recent evidence of endovascular stroke treatment benefit, the need for thromboprophylaxis with systemic anticoagulation during arterial catheterization has been claimed and actually largely employed [5–9]. However due to the lack of evidence,peri-procedural use and doses of IV heparin during mechanical thrombectomy have been mainly at interventionist discretion [10,11]. The aim of our study was to compare efficacy and safety of heparin during mechanical thrombectomy for acute ischemic stroke in a real-world setting.
Safety and Feasibility of Argatroban, Recombinant Tissue Plasminogen Activator, and Intra-Arterial Therapy in Stroke (ARTSS-IA Study)
2018, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :There was no increased risk of ICH or death. Rather, procedural heparin was independently associated with good clinical outcome (mRS 0-2) at 90 days (odds ratio 5.9; 95% confidence interval 1.3-25.9, P = .019).10 Due to the similarities between unfractionated heparin and Argatroban, we did not anticipate significant risk differences with Argatroban compared to heparin in EVT patients.
Dr. Walker is Senior Director of Clinical Research at Concentric Medical, Inc. Dr. Smith holds stock and has received compensation as a consultant for Concentric Medical. He is also an employee of the University of California which holds one of Concentric’s patents. Dr. Nahab and Dr. Dion have no conflicts of interest to disclose.