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Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke

2019; Lippincott Williams & Wilkins; Volume: 50; Issue: 8 Linguagem: Inglês

10.1161/strokeaha.119.025329

1524-4628

Rob A. van de Graaf, Vicky Chalos, Adriaan C.G.M. van Es, Bart J. Emmer, Geert J. Lycklama à Nijeholt, H. Bart van der Worp, Wouter J. Schonewille, Aad van der Lugt, Diederik W.J. Dippel, Hester F. Lingsma, Bob Roozenbeek, Charles B.L.M. Majoie, Yvo B.W.E.M. Roos, Robert van Oostenbrugge, Wim H. van Zwam, Jelis Boiten, Jan Albert Vos, Ivo G.H. Jansen, Maxim J.H.L. Mulder, Robert‐Jan B. Goldhoorn, Kars C.J. Compagne, Manon Kappelhof, Jan Albert Vos, Charles B.L.M. Majoie, Jonathan M. Coutinho, Marieke J.H. Wermer, Marianne van Walderveen, Julie Staals, Wim H. van Zwam, Jeannette Hofmeijer, Jasper M. Martens, Jelis Boiten, Sebastiaan de Bruijn, Lukas van Dijk, Rob H. Lo, Ewoud van Dijk, Hieronymus D. Boogaarts, Paul de Kort, Jo P. Peluso, Jan Berg, Boudewijn van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen den Hertog, Emiel J.C. Sturm, Charles B.L.M. Majoie, Wim H. van Zwam, Marianne van Walderveen, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas van der Kallen, Ido R. van den Wijngaard, Bart J. Emmer, Jasper M. Martens, Lonneke S.F. Yo, Jan Albert Vos, Joost Bot, Pieter‐Jan van Doormaal, Charles B.L.M. Majoie, Yvo B.W.E.M. Roos, Robert van Oostenbrugge, Wim H. van Zwam, Jelis Boiten, Jan Albert Vos, Jeannette Hofmeijer, Jasper M. Martens, Rob H. Lo, Robert van Oostenbrugge, Jeannette Hofmeijer, Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Gert Messchendorp, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, D. Jeurrissen, Ernas Bos, Yvonne Drabbe, Nicoline Aaldering, Berber Zweedijk, Mostafa Khalilzada, Esmée Venema, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Wouter Hinseveld, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka van Kranendonk, Kilian M. Treurniet, Manon L. Tolhuijsen, Heitor Alves,

Cerebrovascular and Carotid Artery Diseases

Background and Purpose- Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use in Dutch stroke intervention centers and to assess its efficacy and safety. Methods- Patients registered between March 2014 and June 2016 in the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke), including all patients treated with endovascular treatment in the Netherlands, were analyzed. The primary outcome was functional outcome (modified Rankin Scale) at 90 days. Secondary outcomes were successful recanalization (extended Thrombolysis in Cerebral Infarction ≥2B), symptomatic intracranial hemorrhage, and mortality at 90 days. We used multilevel regression analysis to evaluate the association of periprocedural intravenous heparin on outcomes, adjusted for center effects and prognostic factors. To account for possible unobserved confounding by indication, we analyzed the effect of center preference to administer intravenous heparin, defined as percentage of patients treated with intravenous heparin in a center, on functional outcome. Results- One thousand four hundred eighty-eight patients from 16 centers were analyzed, of whom 398 (27%) received intravenous heparin (median dose 5000 international units). There was substantial between-center variability in the proportion of patients treated with intravenous heparin (range, 0%-94%). There was no significant difference in functional outcome between patients treated with intravenous heparin and those without (adjusted common odds ratio, 1.17; 95% CI, 0.87-1.56), successful recanalization (adjusted odds ratio, 1.24; 95% CI, 0.89-1.71), symptomatic intracranial hemorrhage (adjusted odds ratio, 1.13; 95% CI, 0.65-1.99), or mortality (adjusted odds ratio, 0.95; 95% CI, 0.66-1.38). Analysis at center level showed that functional outcomes were better in centers with higher percentages of heparin administration (adjusted common odds ratio, 1.07 per 10% more heparin, 95% CI, 1.01-1.13). Conclusions- Substantial between-center variability exists in periprocedural intravenous heparin use during endovascular treatment, but the treatment is safe. Centers using heparin more often had better outcomes. A randomized trial is needed to further study these effects.