Background and Objectives: The use of periprocedural heparin has been reported safe and potentially beneficial during thrombectomy with older generation devices. We aim to investigate the impact of heparin in the era of stent-retrievers.
Methods: A TREVO2 trial post-hoc analysis was performed aiming to compare baseline characteristics and clinical outcomes between patients who received [HEP(+)] versus patients that did not receive periprocedural heparin [HEP(-)].
Results: Out of 173 patients treated in the trial, 58 received a mean 3999 units of periprocedural heparin (n=42 received only pre-procedural bolus for a mean of 2952 units). Baseline characteristics amongst HEP(+) and HEP(-) were similar, with the exception of lower NIHSS (17±5 vs 18±6; p=0.04), IV t-PA use (37 vs 64%; p<0.01), and higher baseline ASPECTS (7.6±1.3 vs 7.1±1.7; p=0.02) in the HEP(+) patients. Occlusion site varied amongst HEP(+) and HEP(-) groups: vertebrobasilar 10 vs 5%; ICA 8 vs 21%; MCA-M1 70 vs 55%; MCA-M2 10 vs 17%; p=0.04, respectively. Time from symptom-onset to puncture was similar, while procedure duration was longer in HEP(+) patients (98±47 vs 82±42min; p<0.01). TICI2b-3 reperfusion rate was comparable (65 vs 62%; p=0.74), as well as embolization to unaffected territory, and access-site complications. Hemorrhagic changes were similar (ECASS HI1/HI2 27 vs 24%; p=0.71 and PH1/PH2 22 vs 25%; p=0.85). Good outcome (mRS0-2) and mortality at 90-days were 40 vs 25% (p=0.07) and 29 vs 27% (p=0.85), respectively. Multivariate logistic regression for good outcome identified the following independent predictors: use of heparin bolus (OR:5.30; 95%CI 1.70-0.16.48; p<0.001), intubation (OR:0.10; 95%CI 0.03-0.33; p<0.001), TICI2b-3 reperfusion (OR:6.56; 95%CI 2.29-18.83; p<0.001), diabetes mellitus (OR:0.11; 95%CI 0.03-0.39; p<0.001), NIHSS (OR:0.84; 95%CI 0.75-0.93; p<0.001), stent-retriever device (OR:3.54; 95%CI 1.28-9.03; p<0.001), time from symptom-onset to puncture (OR:0.64; 95%CI 0.45-0.89; p<0.001), and CHF (OR:0.23; 95%CI 0.06-0.83; p<0.001).
Conclusions: The use of periprocedural heparin in stent-retriever thrombectomy is safe and may have a positive impact on outcomes.