Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke

• DOI: 10.1161/strokeaha.119.025329
• Publication Date: 2019-07-09T09:00:23Z
• Authors: Rob A. van de Graaf; Vicky Chalos; Adriaan C.G.M. va...; Bart J. Emmer; Geert J. Lycklama...; H. Bart van der Worp; Wouter J. Schonew...; Aad van der Lugt; Diederik W.J. Dippel; Hester F. Lingsma; Bob Roozenbeek; ; Charles Majoie; Yvo Roos; Robert van Oosten...; Wim van Zwam; Jelis Boiten; Jan Albert Vos; Ivo Jansen; Maxim Mulder; Robert-Jan Goldhoorn; Kars Compagne; Manon Kappelhof; Jan Albert Vos; Charles Majoie; Jonathan Coutinho; Marieke Wermer; Marianne van Wald...; Julie Staals; Wim van Zwam; Jeannette Hofmeijer; Jasper M. Martens; Jelis Boiten; Sebastiaan de Bruijn; Lukas van Dijk; Rob Lo; Ewoud van Dijk; Hieronymus Boogaarts; Paul de Kort; Jo Peluso; Jan van den Berg; Boudewijn van Has...; Leo Aerden; René Dallinga; Maarten Uyttenboo...; Omid Eshghi; Tobien Schreuder; Roel Heijboer; Koos Keizer; Lonneke Yo; Heleen den Hertog; Emiel Sturm; Charles Majoie; Wim van Zwam; Marianne van Wald...; Marieke Sprengers; Sjoerd Jenniskens; René van den Berg; Albert Yoo; Ludo Beenen; Alida Postma; Stefan Roosendaal; Bas van der Kallen; Ido van den Wijng...; Bart Emmer; Jasper Martens; Lonneke Yo; Jan Albert Vos; Joost Bot; Pieter-Jan van Do...; Charles Majoie; Yvo Roos; Robert van Oosten...; Wim van Zwam; Jelis Boiten; Jan Albert Vos; Jeannette Hofmeijer; Jasper Martens; Rob Lo; Robert van Oosten...; Jeannette Hofmeijer; Zwenneke Flach; Naziha el Ghannouti; Martin Sterrenberg; Corina Puppels; Wilma Pellikaan; Rita Sprengers; Marjan Elfrink; Joke de Meris; Tamara Vermeulen; Annet Geerlings; Gina van Vemde; Tiny Simons; Cathelijn van Rij...; Gert Messchendorp; Hester Bongenaar; Karin Bodde; Sandra Kleijn; Jasmijn Lodico; Hanneke Droste; M. Wollaert; D. Jeurrissen; Ernas Bos; Yvonne Drabbe; Nicoline Aaldering; Berber Zweedijk; Mostafa Khalilzada; Esmee Venema; Ralph Geuskens; Tim van Straaten; Saliha Ergezen; Roger Harmsma; Daan Muijres; Anouk de Jong; Wouter Hinseveld; Olvert Berkhemer; Anna Boers; J. Huguet; P. Groot; Marieke Mens; Katinka van Krane...; Kilian Treurniet; Manon Tolhuijsen; Heitor Alves
• Keywords: Stroke; Fibrinolytic agent

Background and Purpose- Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks benefits this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous use in Dutch intervention centers assess its efficacy safety. Methods- Patients registered between March 2014 June 2016 the MR CLEAN Registry (Multicenter Randomized Clinical Trial Endovascular Treatment Acute Ischemic Stroke), including all patients treated with Netherlands, were analyzed. The primary outcome was functional (modified Rankin Scale) at 90 days. Secondary outcomes successful recanalization (extended Thrombolysis Cerebral Infarction ≥2B), symptomatic intracranial hemorrhage, mortality used multilevel regression analysis association on outcomes, adjusted center effects prognostic factors. To account possible unobserved confounding by indication, we analyzed effect preference administer heparin, defined as percentage a center, outcome. Results- One thousand four hundred eighty-eight from 16 analyzed, whom 398 (27%) received (median dose 5000 international units). There substantial between-center variability proportion (range, 0%-94%). no significant difference those without (adjusted common odds ratio, 1.17; 95% CI, 0.87-1.56), 1.24; 0.89-1.71), hemorrhage 1.13; 0.65-1.99), or 0.95; 0.66-1.38). Analysis level showed that better higher percentages 1.07 per 10% more 1.01-1.13). Conclusions- Substantial exists treatment, but is safe. Centers using often had A randomized trial needed further study these effects.