In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
Abstract:
Background: Intravenous (IV) administration of heparin during endovascular treatment (EVT) for ischemic stroke may improve functional outcome. However, the risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate the use of periprocedural IV heparin 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, including all patients treated with EVT in the Netherlands, were analyzed. We quantified between-center variation and used multilevel logistic and ordinal regression analysis to compare patients treated with and without periprocedural IV heparin, adjusted for center-effects, prognostic factors and time. The primary outcome was functional outcome (modified Rankin Scale) at 90-days. Secondary outcomes were successful recanalization (extended thrombolysis in cerebral infarction ≥ 2B), symptomatic intracerebral hemorrhage (sICH) and mortality at 90-days. To account for possible unobserved confounding by indication we also analyzed the effect of center-preference to administer heparin, defined as percentage of patients treated with heparin in a center, on outcome. Results: A total of 1488 patients from 16 centers were analyzed, of which 398 (27%) patients received IV heparin (median dose 5000 IU). There was substantial between-center variability in heparin use (range: 0%-94%). Analysis at center-level showed that functional outcomes were better in centers with higher percentages of heparin administration (acOR 1.07 per 10% more heparin, 95% CI 1.01-1.13). However, there was no significant difference in functional outcome between patients actually treated with and without IV heparin (adjusted common odds ratio (acOR) 1.17, 95% confidence interval (CI) 0.88-1.56), successful recanalization (aOR 1.21, 95% CI 0.87-1.68), sICH (6% vs. 6%; aOR 1.10, 95% CI 0.63-1.94) and mortality (aOR 0.94, 95% CI 0.65-1.35). Conclusion: Among patients treated with EVT, substantial between-center variability exists in periprocedural IV heparin use. Periprocedural IV heparin use seems a safe adjunctive therapy to EVT. A randomized trial is needed to to assess the effects of periprocedural IV heparin .
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.50.suppl_1.TP6
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
1467823-8
