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 journalArticleAcademicpeer-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 languageEnglish
Article number106726
Number of pages9
JournalJournal of Stroke & Cerebrovascular Diseases
Volume31
Issue number10
Early online date24 Aug 2022
DOIs
Publication statusPublished - Oct 2022

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