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Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes
Affiliations- Neurology Department, Jagiellonian University, Krakow, Poland
- Neurology Department, University Hospital in Krakow
- Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Montelupich 4 Str., 31-155 Krakow, Poland, 31-155 Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland., Jakubowskiego 2, 30-688 Krakow, Poland
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Abstract
Aim of study. Mechanical thrombectomy (MT) is one of the aetiological treatment options recommended for anticoagulated patients with acute ischaemic stroke (AIS). We analysed its long-term outcomes using the modified Rankin Score (mRS) or mortality on day 90.
Clinical rationale for the study. Data describing the anticoagulant efficacy and safety of MT in patients with AIS is limited.
Materials and methods. This study included 291 patients with AIS (49% women, mean [SD] age 66 [15] years) who underwent MT in the Comprehensive Stroke Centre in Krakow, Poland. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography, and time between stroke onset and groin puncture was collected. The outcome measure was the mRS on day 90 after stroke onset (a favourable outcome was defined as an mRS not exceeding 2 points; an unfavourable outcome was death).
Results. Thirty-seven patients (13%) were on therapeutic anticoagulation during MT. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischaemic heart disease, or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or mRS on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of diabetes mellitus, lower NIHSS score on admission, shorter time between stroke onset and groin puncture, and better recanalisation were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR, 1.00; 95%CI, 0.46-2.15; p = 0.99). Anticoagulation did not affect mortality at day 90 (OR, 1.28; 95%CI, 0.56-2.92; p = 0.55).
Conclusion and clinical implications. In anticoagulated patients with AIS, MT does not affect long-term outcomes.
Abstract
Aim of study. Mechanical thrombectomy (MT) is one of the aetiological treatment options recommended for anticoagulated patients with acute ischaemic stroke (AIS). We analysed its long-term outcomes using the modified Rankin Score (mRS) or mortality on day 90.
Clinical rationale for the study. Data describing the anticoagulant efficacy and safety of MT in patients with AIS is limited.
Materials and methods. This study included 291 patients with AIS (49% women, mean [SD] age 66 [15] years) who underwent MT in the Comprehensive Stroke Centre in Krakow, Poland. Data describing demographics, stroke risk factors, NIHSS on admission, postprocedural thrombolysis in cerebral infarction score, 24-hour postprocedural haemorrhagic transformation (ECASS-2) as seen on computed tomography, and time between stroke onset and groin puncture was collected. The outcome measure was the mRS on day 90 after stroke onset (a favourable outcome was defined as an mRS not exceeding 2 points; an unfavourable outcome was death).
Results. Thirty-seven patients (13%) were on therapeutic anticoagulation during MT. Univariate analysis showed that anticoagulated patients were older and more likely to have been diagnosed with hypertension, ischaemic heart disease, or atrial fibrillation. The patient groups did not differ in terms of clot location, postprocedural thrombolysis in cerebral infarction score, haemorrhagic transformation on computed tomography, or mRS on day 90. Multivariate logistic regression analysis showed that younger age, male sex, no history of diabetes mellitus, lower NIHSS score on admission, shorter time between stroke onset and groin puncture, and better recanalisation were associated with favourable outcomes at day 90, and that therapeutic anticoagulation was not (OR, 1.00; 95%CI, 0.46-2.15; p = 0.99). Anticoagulation did not affect mortality at day 90 (OR, 1.28; 95%CI, 0.56-2.92; p = 0.55).
Conclusion and clinical implications. In anticoagulated patients with AIS, MT does not affect long-term outcomes.
Keywords
mechanical thrombectomy, acute ischaemic stroke, novel oral anticoagulants, anticoagulation, atrial fibrillation
About this articleTitle
Mechanical thrombectomy for acute ischaemic stroke during therapeutic anticoagulation: long-term outcomes
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
538-543
Published online
2020-11-17
Page views
2579
Article views/downloads
772
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2020;54(6):538-543.
Keywords
mechanical thrombectomy
acute ischaemic stroke
novel oral anticoagulants
anticoagulation
atrial fibrillation
Authors
Klaudia Nowak
Ewa Włodarczyk
Karolina Porębska
Żaneta Chatys-Bogacka
Jeremiasz Jagiełła
Roman Pułyk
Joanna Słowik
Tadeusz Popiela
Agnieszka Słowik
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