Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany.
J Neurointerv Surg. 2024 Jul 16;16(8):781-787. doi: 10.1136/jnis-2023-020551.
Unfractionated heparin (UFH) bolus is occasionally administered during endovascular treatment (EVT) to reduce thrombotic complications in acute ischemic stroke patients. However, the MR CLEAN-MED trial showed an increase in symptomatic intracranial hemorrhages (sICH) and a non-significant shift towards worse functional outcome with UFH administration. We aimed to analyze the impact of periprocedural UFH bolus in a real-world setting in anterior (ACS) and posterior circulation stroke (PCS) patients.
We analyzed data from the German Stroke Registry-Endovascular Treatment using propensity score matching. Primary outcome was the modified Rankin Scale at 3 months, and secondary outcome measures included mortality, angiographic outcomes, post-EVT National Institute of Health Stroke Scale scores and ICH at 24 hours.
Among 13,082 patients, 7948 with ACS (UFH bolus use in 15%) and 841 with PCS (UFH bolus use in 16.3%) were included in the propensity score matching analysis. Applying MR CLEAN-MED study criteria, UFH bolus was associated with worse functional outcomes (odds ratio [OR] 1.44; 95% CI 1.06-1.96). Analyzing all ACS and PCS patients, UFH bolus did not provide any net benefit. In ACS patients treated with intravenous thrombolysis (IVT), UFH bolus use was associated with worse functional outcomes (OR 2.40; 95% CI 1.34 to 5.06).
Our findings show transferability of the MR CLEAN-MED results into a real-world setting, confirming a negative effect of periprocedural UFH on functional outcome in this subgroup of patients. Considering all ACS and PCS patients, periprocedural UFH did not provide a net benefit and appears to be harmful, particularly in IVT-treated patients.
在急性缺血性脑卒中患者的血管内治疗（EVT）中，偶尔会给予未分级肝素（UFH）推注，以降低血栓并发症的风险。然而，MR CLEAN-MED 试验显示，UFH 给药会增加症状性颅内出血（sICH），且功能结局的改善趋势无统计学意义。我们旨在分析在真实世界环境中，UFH 推注对前循环（ACS）和后循环卒中（PCS）患者的影响。
我们使用倾向评分匹配分析了德国卒中登记处-血管内治疗的数据。主要结局是 3 个月时的改良 Rankin 量表评分，次要结局指标包括死亡率、血管造影结果、EVT 后 24 小时的国立卫生研究院卒中量表评分和 ICH。
在 13082 例患者中，7948 例 ACS 患者（UFH 推注使用率为 15%）和 841 例 PCS 患者（UFH 推注使用率为 16.3%）纳入倾向评分匹配分析。应用 MR CLEAN-MED 研究标准，UFH 推注与较差的功能结局相关（比值比 [OR] 1.44；95%置信区间 [CI] 1.06-1.96）。分析所有 ACS 和 PCS 患者，UFH 推注并未带来任何净获益。在接受静脉溶栓治疗（IVT）的 ACS 患者中，UFH 推注与较差的功能结局相关（OR 2.40；95%CI 1.34 至 5.06）。
我们的研究结果表明，MR CLEAN-MED 研究结果在真实世界环境中具有可转移性，证实了在这组患者中，围手术期 UFH 对功能结局有负面影响。考虑到所有 ACS 和 PCS 患者，围手术期 UFH 并未带来净获益，反而可能有害，特别是在接受 IVT 治疗的患者中。
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