Abstract WP33: Anticoagulation, Mechanical Thrombectomy and rTPA

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Background: There is paucity of data on safety outcomes in the subgroup of patients who are on anticoagulation (AC) that undergo mechanical thrombectomy (MT) for anterior circulation large vessel stroke (AS).

Methods: The Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) data was queried between 2006 and 2010 using validated ICD 9 diagnostic codes for acute ischemic stroke. ICD-9 99.1 for IV tPA and ICD-9 procedure code 39.71 (mechanical thrombectomy) were used. Patients with AS treated with MT were divided into three groups: 1. On AC not receiving iv tPA, 2. On AC receiving iv tPA, 3. Not on AC. Group 3 was subdivided into 3a. Received iv tPA and 3b. Did not receive iv tPA. Mortality, hemorrhagic transformation (HT) and disability at discharge were used to compare outcomes. In addition to demographics, comorbid vascular risk factors, concurrent use of antiplatelet agents, in-hospital complications (DVT, PE, sepsis, hospital acquired infections) were controlled. Patients on novel oral anticoagulants were excluded.

Results: A total of 10,475 AS patients received MT: Group 1- 398 (3.8%), Group 2 - 439 (4.1%), and Group 3 - 9638 (92.1%). Group 3A - 3918 (37.4%) and 3B - 5719 (54.6%). After controlling for confounders, there was no statistically significant increase in the risk of mortality, hemorrhagic transformation and disability at the time of discharge (Table) in Cohort 1 vs. to other cohorts.

Conclusion: The subgroup of patients who are on AC receiving MT for AS with or without tPA did not have an increased risk of HT, mortality or disability.

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