Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA.
World Neurosurg. 2023 Aug;176:e476-e484. doi: 10.1016/j.wneu.2023.05.084. Epub 2023 May 29.
Mechanical thrombectomy (MT) is performed in patients who are already on anticoagulation (AC)/antiplatelet therapy (AP). However, data are insufficient regarding MT's safety and efficacy profiles in these patients.
Investigate the outcome of stroke patients already on anticoagulation/antiplatelet receiving MT.
We included consecutive acute ischemic stroke patients treated with MT for 10 years (2012-2022) in a comprehensive stroke center. Baseline variables, efficacy (recanalization [Thrombolysis in Cerebral Infraction] ≥ 2b), good functional outcome (modified Ranking Scale ≤ 2 at 3 months), and safety (symptomatic intracranial hemorrhage [sICH], mortality rates) were evaluated. Additionally, we conducted a subgroup analysis of patients with prior single-AP versus DAPT.
Six hundred forty-six patients were included (54.5% women, median age 71 years), 84 (13%) were on AC, 196 (30.3%) on AP, and 366 (56.7%) in the control group. The AC and AP groups were older and had more comorbidities. sICH occurred in 7.3% of cases. There was no significant difference in sICH incidence across the groups. The AC group had a lower rate of intravenous thrombolysis (15.9%; P < 0.001), a higher rate of sICH (11.9% vs. AP 7.7% and control 6%; P = 0.172), and higher mortality at discharge (17.9% vs. AP 8.7% and control 10.4%; P = 0.07). However, the groups had similar functional outcomes and mortality rates at 3 months. Successful recanalization was achieved in 92.7% and was similar across groups. Multivariable logistic regression and the subgroup analysis (single-AP vs. dual AP) did not reveal statistically significant associations.
MT in patients with prior anticoagulation and AP presenting with acute ischemic strokeis feasible, effective, and safe.
机械取栓术（MT）在已经接受抗凝（AC）/抗血小板治疗（AP）的患者中进行。然而，关于这些患者接受 MT 的安全性和疗效的数据还不够充分。
调查已经接受抗凝/抗血小板治疗的卒中患者接受 MT 的结果。
我们纳入了一家综合卒中中心在 10 年内（2012-2022 年）连续接受 MT 治疗的急性缺血性卒中患者。评估了基线变量、疗效（血栓切除术溶栓评估标准 2b 级以上）、良好的功能结局（3 个月时改良 Rankin 量表≤2 级）和安全性（症状性颅内出血[sICH]、死亡率）。此外，我们还对既往接受单一抗血小板治疗与双重抗血小板治疗的患者进行了亚组分析。
共纳入 646 例患者（54.5%为女性，中位年龄 71 岁），84 例（13%）正在接受 AC，196 例（30.3%）正在接受 AP，366 例（56.7%）为对照组。AC 组和 AP 组患者年龄较大，合并症更多。sICH 发生率为 7.3%。各组间 sICH 发生率无显著差异。AC 组静脉溶栓率较低（15.9%；P<0.001），sICH 发生率较高（11.9%比 AP 组的 7.7%和对照组的 6%；P=0.172），出院时死亡率较高（17.9%比 AP 组的 8.7%和对照组的 10.4%；P=0.07）。然而，各组在 3 个月时的功能结局和死亡率相似。92.7%的患者获得了成功再通，各组间再通率相似。多变量逻辑回归和亚组分析（单一抗血小板治疗与双重抗血小板治疗）均未发现具有统计学意义的相关性。
在急性缺血性卒中患者中，在已经接受抗凝和抗血小板治疗的基础上进行 MT 是可行的、有效的且安全的。
