Mechanical Thrombectomy in Patients with Acute Ischemic Stroke on Anticoagulation Therapy.
Research article published in Cardiovascular and interventional radiology (2018)
Abstract
INTRODUCTION/PURPOSE: Mechanical thrombectomy (MT) for acute ischemic stroke (IS) can be performed also in patients on anticoagulation therapy (AT); however, sufficient and reliable data about safety and efficacy of MT are still missing. Thus, we aimed to compare these parameters between patients treated on AT and without AT. MATERIALS AND METHODS: All consecutive IS patients treated with MT using stent retrievers were included in the retrospective analysis. Neurological deficit was scored using National Institutes of Health Stroke Scale (NIHSS) and 90-day clinical outcome using modified Rankin scale with a score 0-2 for good outcome. Recanalization was rated using Thrombolysis in Cerebral Infarction (TICI) scale. Symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS-MOST criteria. RESULTS: Out of 703 patients treated with MT, 88 (12.5%) patients (46% males, mean age 75.5 ± 11.8 years) were on AT with an admission median NIHSS of 17 points. Recanalization (TICI 2b-3) was achieved in 80% and complete (TICI 3) in 65% of patients on AT and in 80 and 65% of patients without AT (p-1.000). SICH after MT was detected in 9% of AT and 5% of non-AT patients (p-0.136). Good outcome was present in 36% of AT patients (p-0.03). AT patients with poor outcome had more frequently atrial fibrillation (93%, p-0.005), higher admission NIHSS (17, p-0.004) and higher rate of SICH (14.5%, p-0.047). CONCLUSION: MT seems to be safe also in patients on AT. Poor outcome may be related to higher admission NIHSS, higher rate of SICH and presence of atrial fibrillation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Mechanical thrombectomy (MT) for acute ischemic stroke (IS) can be performed also in patients on anticoagulation therapy (AT); however, sufficient and reliable data about safety and efficacy of MT are still missing. Thus, we aimed to compare these parameters between patients treated on AT and without AT. All consecutive IS patients treated with MT using stent retrievers were included in the retrospective analysis.
Why This Matters for Hirudotherapy
This retrospective analysis of 703 consecutive acute ischemic stroke patients treated with stent-retriever mechanical thrombectomy compared outcomes between 88 patients on anticoagulation therapy (AT) and those not on AT, finding comparable recanalization rates (TICI 2b-3: 80% in both groups) but lower good functional outcome in AT patients (36%, p=0.03), with poor outcome associated with atrial fibrillation, higher admission NIHSS, and higher symptomatic intracerebral hemorrhage rates. For ASH, this study holds relevance because anticoagulants encountered in such stroke populations can include direct thrombin inhibitors such as lepirudin, desirudin, or bivalirudin—drugs derived from or structurally modeled on hirudin, the potent anticoagulant from medicinal leech saliva—so procedural safety data in anticoagulated patients informs broader understanding of hirudin-based anticoagulation in interventional settings. A key caveat: the abstract does not specify which anticoagulants patients received, so no conclusions can be drawn about hirudin-derived agents specifically, and the retrospective design limits causal inference.
Citation
Mechanical Thrombectomy in Patients with Acute Ischemic Stroke on Anticoagulation Therapy.
Černík et al. · Cardiovascular and interventional radiology, 2018
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