Abstract：
OBJECTIVE: The benefit-to-risk ratio of periprocedural heparin in patients treated with endovascular thrombectomy (EVT) after intravenous thrombolysis (IVT) remains unclear. This study aimed to evaluate the potential effects of periprocedural heparin on clinical outcomes of EVT after IVT.
METHODS: The authors retrospectively analyzed patients from multicenter studies treated with EVT after IVT in the anterior circulation. The endpoints were unfavorable outcome (defined as modified Rankin Scale score ≥ 3 at 90 days), 90-day mortality, symptomatic intracranial hemorrhage (SICH), successful recanalization, and early neurological deterioration. Patients were divided into two groups based on whether they were treated with heparin (heparin-treated group) or not (untreated group), and the efficacy and safety outcomes were compared using multivariable logistic regression models and propensity score-matching methods.
RESULTS: Among the 322 included patients (mean age 67.4 years, 54.3% male), 32% of patients received periprocedural heparin. In multivariable analyses, the administration of periprocedural heparin was a significant predictor for unfavorable outcome (OR 2.821, 95% CI 1.15-7.326; p = 0.027), SICH (OR 24.925, 95% CI 2.363-780.262; p = 0.025), and early neurological deterioration (OR 5.344, 95% CI 1.299-28.040; p = 0.029). Regarding successful recanalization and death, no significant differences between the groups were found after propensity score matching.
CONCLUSIONS: The results showed that periprocedural heparin is associated with an increased risk of unfavorable outcomes and SICH in patients treated with EVT after IVT. Further studies are warranted to evaluate the utility and safety of periprocedural heparin.
METHODS: The authors retrospectively analyzed patients from multicenter studies treated with EVT after IVT in the anterior circulation. The endpoints were unfavorable outcome (defined as modified Rankin Scale score ≥ 3 at 90 days), 90-day mortality, symptomatic intracranial hemorrhage (SICH), successful recanalization, and early neurological deterioration. Patients were divided into two groups based on whether they were treated with heparin (heparin-treated group) or not (untreated group), and the efficacy and safety outcomes were compared using multivariable logistic regression models and propensity score-matching methods.
RESULTS: Among the 322 included patients (mean age 67.4 years, 54.3% male), 32% of patients received periprocedural heparin. In multivariable analyses, the administration of periprocedural heparin was a significant predictor for unfavorable outcome (OR 2.821, 95% CI 1.15-7.326; p = 0.027), SICH (OR 24.925, 95% CI 2.363-780.262; p = 0.025), and early neurological deterioration (OR 5.344, 95% CI 1.299-28.040; p = 0.029). Regarding successful recanalization and death, no significant differences between the groups were found after propensity score matching.
CONCLUSIONS: The results showed that periprocedural heparin is associated with an increased risk of unfavorable outcomes and SICH in patients treated with EVT after IVT. Further studies are warranted to evaluate the utility and safety of periprocedural heparin.
摘要：
目的：静脉溶栓（IVT）后接受血管内血栓切除术（EVT）的患者围手术期肝素的获益风险比尚不清楚。本研究旨在评估围手术期肝素对IVT后EVT临床结局的潜在影响。
方法：作者回顾性分析了前循环IVT后接受EVT治疗的多中心研究患者。终点为不良结局（定义为90天时改良Rankin量表评分≥3），90天死亡率，症状性颅内出血（SICH），成功的再通,和早期神经退化。根据患者是否接受肝素治疗（肝素治疗组）或未接受肝素治疗（未治疗组）分为两组，使用多变量逻辑回归模型和倾向评分匹配方法比较疗效和安全性结局.
结果：在322名患者中（平均年龄67.4岁，54.3%男性），32%的患者接受围手术期肝素治疗。在多变量分析中，围手术期肝素的给药是不良结局的显著预测因子(OR2.821,95%CI1.15-7.326;p=0.027),SICH（OR24.925，95%CI2.363-780.262；p=0.025），和早期神经系统恶化（OR5.344，95％CI1.299-28.040；p=0.029）。关于成功的再通和死亡，倾向评分匹配后,组间无显著差异.
结论：结果显示，在IVT后接受EVT治疗的患者中，围手术期肝素与不良结局和SICH的风险增加相关。需要进一步的研究来评估围手术期肝素的实用性和安全性。
方法：作者回顾性分析了前循环IVT后接受EVT治疗的多中心研究患者。终点为不良结局（定义为90天时改良Rankin量表评分≥3），90天死亡率，症状性颅内出血（SICH），成功的再通,和早期神经退化。根据患者是否接受肝素治疗（肝素治疗组）或未接受肝素治疗（未治疗组）分为两组，使用多变量逻辑回归模型和倾向评分匹配方法比较疗效和安全性结局.
结果：在322名患者中（平均年龄67.4岁，54.3%男性），32%的患者接受围手术期肝素治疗。在多变量分析中，围手术期肝素的给药是不良结局的显著预测因子(OR2.821,95%CI1.15-7.326;p=0.027),SICH（OR24.925，95%CI2.363-780.262；p=0.025），和早期神经系统恶化（OR5.344，95％CI1.299-28.040；p=0.029）。关于成功的再通和死亡，倾向评分匹配后,组间无显著差异.
结论：结果显示，在IVT后接受EVT治疗的患者中，围手术期肝素与不良结局和SICH的风险增加相关。需要进一步的研究来评估围手术期肝素的实用性和安全性。
