Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment

Wouter van der Steen; P Matthijs van der Sluijs; Rob A van de Graaf; Ruisheng Su; Lennard Wolff; Henk van Voorst; Heleen M den Hertog; Pieter Jan van Doormaal; Adriaan C G M van Es; Julie Staals; Wim van Zwam; Hester F Lingsma; René van den Berg; Charles B L M Majoie; Aad van der Lugt; Diederik W J Dippel; Bob Roozenbeek; MR CLEAN-MED investigators

doi:10.1016/j.jstrokecerebrovasdis.2022.106726

Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment

Wouter van der Steen^*, P Matthijs van der Sluijs, Rob A van de Graaf, Ruisheng Su, Lennard Wolff, Henk van Voorst, Heleen M den Hertog, Pieter Jan van Doormaal, Adriaan C G M van Es, Julie Staals, Wim van Zwam, Hester F Lingsma, René van den Berg, Charles B L M Majoie, Aad van der Lugt, Diederik W J Dippel, Bob Roozenbeek, MR CLEAN-MED investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure.

MATERIALS AND METHODS: We performed a post-hoc analysis of the MR CLEAN-MED trial, including adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular treatment (EVT). In this trial, patients were randomized for periprocedural intravenous treatment with aspirin or no aspirin (1:1 ratio), and for moderate-dose unfractionated heparin, low-dose unfractionated heparin or no unfractionated heparin (1:1:1 ratio). We tested for interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and treatment with periprocedural medication with multivariable regression analyses. The primary outcome was the modified Rankin Scale score at 90 days. Secondary outcomes were final infarct volume, intracranial hemorrhage, and symptomatic intracranial hemorrhage.

RESULTS: Of 534 included patients, 93 (17%) had a post-EVT eTICI score of 0-2a, 115 (22%) a score of 2b, 73 (14%) a score of 2c, and 253 (47%) a score of 3. For both aspirin and heparin, we found no interaction between post-EVT eTICI score and treatment on the modified Rankin Scale score (p=0.76 and p=0.47, respectively). We found an interaction between post-EVT eTICI score and treatment with heparin on the final infarct volume (p=0.01). Of note, this interaction showed a biologically implausible distribution over the subgroups.

CONCLUSIONS: The overall harmful effect of periprocedural aspirin and unfractionated heparin is not different in patients with a successful reperfusion after EVT.

Original language	English
Article number	106726
Number of pages	9
Journal	Journal of Stroke & Cerebrovascular Diseases
Volume	31
Issue number	10
Early online date	24 Aug 2022
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106726
Publication status	Published - Oct 2022

Access to Document

10.1016/j.jstrokecerebrovasdis.2022.106726Licence: CC BY

Cite this

van der Steen, W., van der Sluijs, P. M., van de Graaf, R. A., Su, R., Wolff, L., van Voorst, H., den Hertog, H. M., van Doormaal, P. J., van Es, A. C. G. M., Staals, J., van Zwam, W., Lingsma, H. F., van den Berg, R., Majoie, C. B. L. M., van der Lugt, A., Dippel, D. W. J., Roozenbeek, B., & MR CLEAN-MED investigators (2022). Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment. Journal of Stroke & Cerebrovascular Diseases, 31(10), Article 106726. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106726

@article{68fde83aa9824cdba5371c0d94e1e527,

title = "Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment",

abstract = "OBJECTIVES: We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure.MATERIALS AND METHODS: We performed a post-hoc analysis of the MR CLEAN-MED trial, including adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular treatment (EVT). In this trial, patients were randomized for periprocedural intravenous treatment with aspirin or no aspirin (1:1 ratio), and for moderate-dose unfractionated heparin, low-dose unfractionated heparin or no unfractionated heparin (1:1:1 ratio). We tested for interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and treatment with periprocedural medication with multivariable regression analyses. The primary outcome was the modified Rankin Scale score at 90 days. Secondary outcomes were final infarct volume, intracranial hemorrhage, and symptomatic intracranial hemorrhage.RESULTS: Of 534 included patients, 93 (17%) had a post-EVT eTICI score of 0-2a, 115 (22%) a score of 2b, 73 (14%) a score of 2c, and 253 (47%) a score of 3. For both aspirin and heparin, we found no interaction between post-EVT eTICI score and treatment on the modified Rankin Scale score (p=0.76 and p=0.47, respectively). We found an interaction between post-EVT eTICI score and treatment with heparin on the final infarct volume (p=0.01). Of note, this interaction showed a biologically implausible distribution over the subgroups.CONCLUSIONS: The overall harmful effect of periprocedural aspirin and unfractionated heparin is not different in patients with a successful reperfusion after EVT.",

author = "{van der Steen}, Wouter and {van der Sluijs}, {P Matthijs} and {van de Graaf}, {Rob A} and Ruisheng Su and Lennard Wolff and {van Voorst}, Henk and {den Hertog}, {Heleen M} and {van Doormaal}, {Pieter Jan} and {van Es}, {Adriaan C G M} and Julie Staals and {van Zwam}, Wim and Lingsma, {Hester F} and {van den Berg}, Ren{\'e} and Majoie, {Charles B L M} and {van der Lugt}, Aad and Dippel, {Diederik W J} and Bob Roozenbeek and {MR CLEAN-MED investigators}",

year = "2022",

month = oct,

doi = "10.1016/j.jstrokecerebrovasdis.2022.106726",

language = "English",

volume = "31",

journal = "Journal of Stroke & Cerebrovascular Diseases",

issn = "1052-3057",

publisher = "Elsevier",

number = "10",

}

van der Steen, W, van der Sluijs, PM, van de Graaf, RA, Su, R, Wolff, L, van Voorst, H, den Hertog, HM, van Doormaal, PJ, van Es, ACGM, Staals, J , van Zwam, W, Lingsma, HF, van den Berg, R, Majoie, CBLM, van der Lugt, A, Dippel, DWJ, Roozenbeek, B & MR CLEAN-MED investigators 2022, 'Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment', Journal of Stroke & Cerebrovascular Diseases, vol. 31, no. 10, 106726. https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106726

Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment. / van der Steen, Wouter; van der Sluijs, P Matthijs; van de Graaf, Rob A et al.
In: Journal of Stroke & Cerebrovascular Diseases, Vol. 31, No. 10, 106726, 10.2022.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment

AU - van der Steen, Wouter

AU - van der Sluijs, P Matthijs

AU - van de Graaf, Rob A

AU - Su, Ruisheng

AU - Wolff, Lennard

AU - van Voorst, Henk

AU - den Hertog, Heleen M

AU - van Doormaal, Pieter Jan

AU - van Es, Adriaan C G M

AU - Staals, Julie

AU - van Zwam, Wim

AU - Lingsma, Hester F

AU - van den Berg, René

AU - Majoie, Charles B L M

AU - van der Lugt, Aad

AU - Dippel, Diederik W J

AU - Roozenbeek, Bob

AU - MR CLEAN-MED investigators

PY - 2022/10

Y1 - 2022/10

N2 - OBJECTIVES: We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure.MATERIALS AND METHODS: We performed a post-hoc analysis of the MR CLEAN-MED trial, including adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular treatment (EVT). In this trial, patients were randomized for periprocedural intravenous treatment with aspirin or no aspirin (1:1 ratio), and for moderate-dose unfractionated heparin, low-dose unfractionated heparin or no unfractionated heparin (1:1:1 ratio). We tested for interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and treatment with periprocedural medication with multivariable regression analyses. The primary outcome was the modified Rankin Scale score at 90 days. Secondary outcomes were final infarct volume, intracranial hemorrhage, and symptomatic intracranial hemorrhage.RESULTS: Of 534 included patients, 93 (17%) had a post-EVT eTICI score of 0-2a, 115 (22%) a score of 2b, 73 (14%) a score of 2c, and 253 (47%) a score of 3. For both aspirin and heparin, we found no interaction between post-EVT eTICI score and treatment on the modified Rankin Scale score (p=0.76 and p=0.47, respectively). We found an interaction between post-EVT eTICI score and treatment with heparin on the final infarct volume (p=0.01). Of note, this interaction showed a biologically implausible distribution over the subgroups.CONCLUSIONS: The overall harmful effect of periprocedural aspirin and unfractionated heparin is not different in patients with a successful reperfusion after EVT.

AB - OBJECTIVES: We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure.MATERIALS AND METHODS: We performed a post-hoc analysis of the MR CLEAN-MED trial, including adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular treatment (EVT). In this trial, patients were randomized for periprocedural intravenous treatment with aspirin or no aspirin (1:1 ratio), and for moderate-dose unfractionated heparin, low-dose unfractionated heparin or no unfractionated heparin (1:1:1 ratio). We tested for interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and treatment with periprocedural medication with multivariable regression analyses. The primary outcome was the modified Rankin Scale score at 90 days. Secondary outcomes were final infarct volume, intracranial hemorrhage, and symptomatic intracranial hemorrhage.RESULTS: Of 534 included patients, 93 (17%) had a post-EVT eTICI score of 0-2a, 115 (22%) a score of 2b, 73 (14%) a score of 2c, and 253 (47%) a score of 3. For both aspirin and heparin, we found no interaction between post-EVT eTICI score and treatment on the modified Rankin Scale score (p=0.76 and p=0.47, respectively). We found an interaction between post-EVT eTICI score and treatment with heparin on the final infarct volume (p=0.01). Of note, this interaction showed a biologically implausible distribution over the subgroups.CONCLUSIONS: The overall harmful effect of periprocedural aspirin and unfractionated heparin is not different in patients with a successful reperfusion after EVT.

U2 - 10.1016/j.jstrokecerebrovasdis.2022.106726

DO - 10.1016/j.jstrokecerebrovasdis.2022.106726

M3 - Article

C2 - 36029687

SN - 1052-3057

VL - 31

JO - Journal of Stroke & Cerebrovascular Diseases

JF - Journal of Stroke & Cerebrovascular Diseases

IS - 10

M1 - 106726

ER -