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Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke: Results From the MR CLEAN Registry.
van de Graaf, Rob A; Chalos, Vicky; van Es, Adriaan C G M; Emmer, Bart J; Lycklama À Nijeholt, Geert J; van der Worp, H Bart; Schonewille, Wouter J; van der Lugt, Aad; Dippel, Diederik W J; Lingsma, Hester F; Roozenbeek, Bob.
Afiliación
  • van de Graaf RA; From the Department of Neurology (R.A.v.d.G., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • Chalos V; Department of Radiology and Nuclear Medicine (R.A.v.d.G., V.C., A.C.G.M.v.E., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • van Es ACGM; From the Department of Neurology (R.A.v.d.G., V.C., D.W.J.D., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • Emmer BJ; Department of Radiology and Nuclear Medicine (R.A.v.d.G., V.C., A.C.G.M.v.E., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • Lycklama À Nijeholt GJ; Department of Public Health (V.C., H.F.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • van der Worp HB; Department of Radiology and Nuclear Medicine (R.A.v.d.G., V.C., A.C.G.M.v.E., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • Schonewille WJ; Department of Radiology, Amsterdam University Medical Center, location AMC, the Netherlands (B.L.E.).
  • van der Lugt A; Department of Radiology, Haaglanden Medical Center, Den Haag, the Netherlands (G.J.L.N.).
  • Dippel DWJ; Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, the Netherlands (H.B.v.d.W.).
  • Lingsma HF; Department of Neurology, Sint Antonius Hospital, Nieuwegein, the Netherlands (W.J.S.).
  • Roozenbeek B; Department of Radiology and Nuclear Medicine (R.A.v.d.G., V.C., A.C.G.M.v.E., A.v.d.L., B.R.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Stroke ; 50(8): 2147-2155, 2019 08.
Article en En | MEDLINE | ID: mdl-31860411
ABSTRACT
Background and Purpose- Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use 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 (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke), including all patients treated with endovascular treatment in the Netherlands, were analyzed. The primary outcome was functional outcome (modified Rankin Scale) at 90 days. Secondary outcomes were successful recanalization (extended Thrombolysis in Cerebral Infarction ≥2B), symptomatic intracranial hemorrhage, and mortality at 90 days. We used multilevel regression analysis to evaluate the association of periprocedural intravenous heparin on outcomes, adjusted for center effects and prognostic factors. To account for possible unobserved confounding by indication, we analyzed the effect of center preference to administer intravenous heparin, defined as percentage of patients treated with intravenous heparin in a center, on functional outcome. Results- One thousand four hundred eighty-eight patients from 16 centers were analyzed, of whom 398 (27%) received intravenous heparin (median dose 5000 international units). There was substantial between-center variability in the proportion of patients treated with intravenous heparin (range, 0%-94%). There was no significant difference in functional outcome between patients treated with intravenous heparin and those without (adjusted common odds ratio, 1.17; 95% CI, 0.87-1.56), successful recanalization (adjusted odds ratio, 1.24; 95% CI, 0.89-1.71), symptomatic intracranial hemorrhage (adjusted odds ratio, 1.13; 95% CI, 0.65-1.99), or mortality (adjusted odds ratio, 0.95; 95% CI, 0.66-1.38). Analysis at center level showed that functional outcomes were better in centers with higher percentages of heparin administration (adjusted common odds ratio, 1.07 per 10% more heparin, 95% CI, 1.01-1.13). Conclusions- Substantial between-center variability exists in periprocedural intravenous heparin use during endovascular treatment, but the treatment is safe. Centers using heparin more often had better outcomes. A randomized trial is needed to further study these effects.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Heparina / Activador de Plasminógeno de Tipo Uroquinasa / Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Fibrinolíticos / Anticoagulantes Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Heparina / Activador de Plasminógeno de Tipo Uroquinasa / Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Fibrinolíticos / Anticoagulantes Tipo de estudio: Clinical_trials / Prognostic_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article País de afiliación: Países Bajos
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