Original Article
Safety of Periprocedural Heparin in Acute Ischemic Stroke Endovascular Therapy: The Multi MERCI Trial

https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.04.009Get rights and content

Background

There are limited data on the safety of periprocedural heparin in acute ischemic stroke endovascular therapy.

Methods

A post hoc analysis was performed on patients enrolled in the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial to compare baseline characteristics and clinical outcomes between patients who received periprocedural heparin (HEP+) with patients who did not receive periprocedural heparin (HEP). Data on periprocedural heparin use or nonuse was collected on patients enrolled between February 1, 2006 and July 31, 2006.

Results

Of 51 patients included in the analysis cohort, 24 (47%) received periprocedural heparin with a median dose of 3000 U. Baseline and procedural characteristics were similar between the 2 groups, although HEP+ patients were more likely to have vertebral or basilar occlusion than HEP patients (16.7% v 0%; P = .04). There was no significant difference in rates of hemorrhage, procedural complications, or 90-day mortality between the 2 groups. In multivariable analysis, a 90-day good outcome (modified Rankin scale score of 0-2) was associated with age (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.86-0.98; P = .0104), final revascularization success (OR 6.86; 95% CI 1.39-33.81; P = .0179), and periprocedural heparin use (OR 5.89; 95% CI 1.34-25.92; P = .0189).

Conclusions

In this small subgroup of the Multi MERCI trial, periprocedural heparin use in acute ischemic stroke 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 warrants further study in a larger cohort.

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

References (13)

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    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.

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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.

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