Periprocedural heparin use in acute ischemic stroke endovascular therapy

the TREVO 2 trial

Melanie J. Winningham, Diogo C. Haussen, Raul G. Nogueira, David S. Liebeskind, Wade S. Smith, Helmi Lutsep, Tudor G. Jovin, Bin Xiang, Fadi Nahab

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era.

METHODS: A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP-) while undergoing MERCI or TREVO clot retrieval.

RESULTS: Of 173 patients, 58 (34%) received periprocedural heparin including 40 who received one preprocedural bolus (median 3000 units). Baseline characteristics among HEP+ and HEP- patients were similar except HEP+ patients had a lower NIH Stroke Scale (NIHSS) score (17 vs 19; p=0.04), lower IV tissue plasminogen activator use (38% vs 64%; p<0.01), and a higher median ASPECTS score (8.0 vs 7.0; p=0.02). HEP+ patients were more likely to have vertebrobasilar and middle cerebral artery (MCA)-M1 occlusions but less likely to have internal carotid artery and MCA-M2 occlusions (p=0.04). Time from symptom onset to puncture was similar in the two groups while procedure duration was longer in HEP+ patients (99 vs 83 min; p<0.01). Thrombolysis In Cerebral Infarction (TICI) 2b-3 reperfusion rates, embolization to unaffected territories, access site complications, and intracranial hemorrhages were similar between the groups. In multivariable logistic regression, a good outcome (90-day modified Rankin Scale score 0-2) was independently associated with heparin bolus use (OR 5.30; 95% CI 1.70 to 16.48), TICI 2b-3 reperfusion (OR 6.56; 95% CI 2.29 to 18.83), stent retriever use (OR 3.54; 95% CI 1.38 to 9.03) and inversely associated with intubation (OR 0.10; 95% CI 0.03 to 0.33), diabetes (OR 0.11; 95% CI 0.03 to 0.39), NIHSS (OR 0.84; 95% CI 0.75 to 0.93), time from symptom onset to puncture (OR 0.64; 95% CI 0.45 to 0.89), and heart failure (OR 0.23; 95% CI 0.06 to 0.83).

CONCLUSIONS: The use of periprocedural heparin in stent retriever thrombectomy is associated with a good clinical outcome at 90 days and similar rates of symptomatic intracranial hemorrhage. Further studies are warranted.

CLINICAL TRIAL REGISTRATION: URL:http://www.clinicaltrials.gov. Unique identifier: NCT01270867;Post-results.

Original languageEnglish (US)
Pages (from-to)611-614
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume10
Issue number7
DOIs
StatePublished - Jul 1 2018

Fingerprint

Heparin
Stroke
Stents
Thrombectomy
Intracranial Hemorrhages
Middle Cerebral Artery Infarction
Cerebral Infarction
Punctures
Reperfusion
Therapeutics
Internal Carotid Artery
Tissue Plasminogen Activator
Intubation
Heart Failure
Logistic Models
Clinical Trials
Safety
Equipment and Supplies

Keywords

  • brain
  • complication
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Winningham, M. J., Haussen, D. C., Nogueira, R. G., Liebeskind, D. S., Smith, W. S., Lutsep, H., ... Nahab, F. (2018). Periprocedural heparin use in acute ischemic stroke endovascular therapy: the TREVO 2 trial. Journal of NeuroInterventional Surgery, 10(7), 611-614. https://doi.org/10.1136/neurintsurg-2017-013441

Periprocedural heparin use in acute ischemic stroke endovascular therapy : the TREVO 2 trial. / Winningham, Melanie J.; Haussen, Diogo C.; Nogueira, Raul G.; Liebeskind, David S.; Smith, Wade S.; Lutsep, Helmi; Jovin, Tudor G.; Xiang, Bin; Nahab, Fadi.

In: Journal of NeuroInterventional Surgery, Vol. 10, No. 7, 01.07.2018, p. 611-614.

Research output: Contribution to journalArticle

Winningham, MJ, Haussen, DC, Nogueira, RG, Liebeskind, DS, Smith, WS, Lutsep, H, Jovin, TG, Xiang, B & Nahab, F 2018, 'Periprocedural heparin use in acute ischemic stroke endovascular therapy: the TREVO 2 trial', Journal of NeuroInterventional Surgery, vol. 10, no. 7, pp. 611-614. https://doi.org/10.1136/neurintsurg-2017-013441
Winningham, Melanie J. ; Haussen, Diogo C. ; Nogueira, Raul G. ; Liebeskind, David S. ; Smith, Wade S. ; Lutsep, Helmi ; Jovin, Tudor G. ; Xiang, Bin ; Nahab, Fadi. / Periprocedural heparin use in acute ischemic stroke endovascular therapy : the TREVO 2 trial. In: Journal of NeuroInterventional Surgery. 2018 ; Vol. 10, No. 7. pp. 611-614.
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abstract = "BACKGROUND: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era.METHODS: A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP-) while undergoing MERCI or TREVO clot retrieval.RESULTS: Of 173 patients, 58 (34{\%}) received periprocedural heparin including 40 who received one preprocedural bolus (median 3000 units). Baseline characteristics among HEP+ and HEP- patients were similar except HEP+ patients had a lower NIH Stroke Scale (NIHSS) score (17 vs 19; p=0.04), lower IV tissue plasminogen activator use (38{\%} vs 64{\%}; p<0.01), and a higher median ASPECTS score (8.0 vs 7.0; p=0.02). HEP+ patients were more likely to have vertebrobasilar and middle cerebral artery (MCA)-M1 occlusions but less likely to have internal carotid artery and MCA-M2 occlusions (p=0.04). Time from symptom onset to puncture was similar in the two groups while procedure duration was longer in HEP+ patients (99 vs 83 min; p<0.01). Thrombolysis In Cerebral Infarction (TICI) 2b-3 reperfusion rates, embolization to unaffected territories, access site complications, and intracranial hemorrhages were similar between the groups. In multivariable logistic regression, a good outcome (90-day modified Rankin Scale score 0-2) was independently associated with heparin bolus use (OR 5.30; 95{\%} CI 1.70 to 16.48), TICI 2b-3 reperfusion (OR 6.56; 95{\%} CI 2.29 to 18.83), stent retriever use (OR 3.54; 95{\%} CI 1.38 to 9.03) and inversely associated with intubation (OR 0.10; 95{\%} CI 0.03 to 0.33), diabetes (OR 0.11; 95{\%} CI 0.03 to 0.39), NIHSS (OR 0.84; 95{\%} CI 0.75 to 0.93), time from symptom onset to puncture (OR 0.64; 95{\%} CI 0.45 to 0.89), and heart failure (OR 0.23; 95{\%} CI 0.06 to 0.83).CONCLUSIONS: The use of periprocedural heparin in stent retriever thrombectomy is associated with a good clinical outcome at 90 days and similar rates of symptomatic intracranial hemorrhage. Further studies are warranted.CLINICAL TRIAL REGISTRATION: URL:http://www.clinicaltrials.gov. Unique identifier: NCT01270867;Post-results.",
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author = "Winningham, {Melanie J.} and Haussen, {Diogo C.} and Nogueira, {Raul G.} and Liebeskind, {David S.} and Smith, {Wade S.} and Helmi Lutsep and Jovin, {Tudor G.} and Bin Xiang and Fadi Nahab",
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TY - JOUR

T1 - Periprocedural heparin use in acute ischemic stroke endovascular therapy

T2 - the TREVO 2 trial

AU - Winningham, Melanie J.

AU - Haussen, Diogo C.

AU - Nogueira, Raul G.

AU - Liebeskind, David S.

AU - Smith, Wade S.

AU - Lutsep, Helmi

AU - Jovin, Tudor G.

AU - Xiang, Bin

AU - Nahab, Fadi

PY - 2018/7/1

Y1 - 2018/7/1

N2 - BACKGROUND: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era.METHODS: A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP-) while undergoing MERCI or TREVO clot retrieval.RESULTS: Of 173 patients, 58 (34%) received periprocedural heparin including 40 who received one preprocedural bolus (median 3000 units). Baseline characteristics among HEP+ and HEP- patients were similar except HEP+ patients had a lower NIH Stroke Scale (NIHSS) score (17 vs 19; p=0.04), lower IV tissue plasminogen activator use (38% vs 64%; p<0.01), and a higher median ASPECTS score (8.0 vs 7.0; p=0.02). HEP+ patients were more likely to have vertebrobasilar and middle cerebral artery (MCA)-M1 occlusions but less likely to have internal carotid artery and MCA-M2 occlusions (p=0.04). Time from symptom onset to puncture was similar in the two groups while procedure duration was longer in HEP+ patients (99 vs 83 min; p<0.01). Thrombolysis In Cerebral Infarction (TICI) 2b-3 reperfusion rates, embolization to unaffected territories, access site complications, and intracranial hemorrhages were similar between the groups. In multivariable logistic regression, a good outcome (90-day modified Rankin Scale score 0-2) was independently associated with heparin bolus use (OR 5.30; 95% CI 1.70 to 16.48), TICI 2b-3 reperfusion (OR 6.56; 95% CI 2.29 to 18.83), stent retriever use (OR 3.54; 95% CI 1.38 to 9.03) and inversely associated with intubation (OR 0.10; 95% CI 0.03 to 0.33), diabetes (OR 0.11; 95% CI 0.03 to 0.39), NIHSS (OR 0.84; 95% CI 0.75 to 0.93), time from symptom onset to puncture (OR 0.64; 95% CI 0.45 to 0.89), and heart failure (OR 0.23; 95% CI 0.06 to 0.83).CONCLUSIONS: The use of periprocedural heparin in stent retriever thrombectomy is associated with a good clinical outcome at 90 days and similar rates of symptomatic intracranial hemorrhage. Further studies are warranted.CLINICAL TRIAL REGISTRATION: URL:http://www.clinicaltrials.gov. Unique identifier: NCT01270867;Post-results.

AB - BACKGROUND: The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era.METHODS: A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP-) while undergoing MERCI or TREVO clot retrieval.RESULTS: Of 173 patients, 58 (34%) received periprocedural heparin including 40 who received one preprocedural bolus (median 3000 units). Baseline characteristics among HEP+ and HEP- patients were similar except HEP+ patients had a lower NIH Stroke Scale (NIHSS) score (17 vs 19; p=0.04), lower IV tissue plasminogen activator use (38% vs 64%; p<0.01), and a higher median ASPECTS score (8.0 vs 7.0; p=0.02). HEP+ patients were more likely to have vertebrobasilar and middle cerebral artery (MCA)-M1 occlusions but less likely to have internal carotid artery and MCA-M2 occlusions (p=0.04). Time from symptom onset to puncture was similar in the two groups while procedure duration was longer in HEP+ patients (99 vs 83 min; p<0.01). Thrombolysis In Cerebral Infarction (TICI) 2b-3 reperfusion rates, embolization to unaffected territories, access site complications, and intracranial hemorrhages were similar between the groups. In multivariable logistic regression, a good outcome (90-day modified Rankin Scale score 0-2) was independently associated with heparin bolus use (OR 5.30; 95% CI 1.70 to 16.48), TICI 2b-3 reperfusion (OR 6.56; 95% CI 2.29 to 18.83), stent retriever use (OR 3.54; 95% CI 1.38 to 9.03) and inversely associated with intubation (OR 0.10; 95% CI 0.03 to 0.33), diabetes (OR 0.11; 95% CI 0.03 to 0.39), NIHSS (OR 0.84; 95% CI 0.75 to 0.93), time from symptom onset to puncture (OR 0.64; 95% CI 0.45 to 0.89), and heart failure (OR 0.23; 95% CI 0.06 to 0.83).CONCLUSIONS: The use of periprocedural heparin in stent retriever thrombectomy is associated with a good clinical outcome at 90 days and similar rates of symptomatic intracranial hemorrhage. Further studies are warranted.CLINICAL TRIAL REGISTRATION: URL:http://www.clinicaltrials.gov. Unique identifier: NCT01270867;Post-results.

KW - brain

KW - complication

KW - stroke

KW - thrombectomy

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