Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment

Wouter van der Steen*, P. Matthijs van der Sluijs, MR CLEAN-MED investigators, Rob A. van de Graaf, Ruisheng Su, Lennard Wolff, Henk van Voorst, Heleen M. den Hertog, Pieter Jan van Doormaal, Adriaan C.G.M. van Es, Julie Staals, Wim van Zwam, Hester F. Lingsma, René van den Berg, Charles B.L.M. Majoie, Aad van der Lugt, Diederik W.J. Dippel, Bob Roozenbeek

*Corresponding author for this work

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Objectives: We aimed to evaluate whether the overall harmful effect of periprocedural treatment with aspirin or heparin during endovascular stroke treatment is different in patients with a successful reperfusion after the procedure. Materials and methods: We performed a post-hoc analysis of the MR CLEAN-MED trial, including adult patients with a large vessel occlusion in the anterior circulation eligible for endovascular treatment (EVT). In this trial, patients were randomized for periprocedural intravenous treatment with aspirin or no aspirin (1:1 ratio), and for moderate-dose unfractionated heparin, low-dose unfractionated heparin or no unfractionated heparin (1:1:1 ratio). We tested for interaction between the post-EVT extended thrombolysis in cerebral infarction (eTICI) score and treatment with periprocedural medication with multivariable regression analyses. The primary outcome was the modified Rankin Scale score at 90 days. Secondary outcomes were final infarct volume, intracranial hemorrhage, and symptomatic intracranial hemorrhage. Results: Of 534 included patients, 93 (17%) had a post-EVT eTICI score of 0-2a, 115 (22%) a score of 2b, 73 (14%) a score of 2c, and 253 (47%) a score of 3. For both aspirin and heparin, we found no interaction between post-EVT eTICI score and treatment on the modified Rankin Scale score (p=0.76 and p=0.47, respectively). We found an interaction between post-EVT eTICI score and treatment with heparin on the final infarct volume (p=0.01). Of note, this interaction showed a biologically implausible distribution over the subgroups. Conclusions: The overall harmful effect of periprocedural aspirin and unfractionated heparin is not different in patients with a successful reperfusion after EVT.

Original languageEnglish
Article number106726
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number10
Early online date24 Aug 2022
Publication statusPublished - 1 Oct 2022

Bibliographical note

Funding Information:
The MR CLEAN-MED was funded through the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST); and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by Top Sector Life Sciences & Health to stimulate public–private partnerships (LSHM17016). This work was funded in part through unrestricted funding by Stryker, Medtronic, and Cerenovus.

Funding Information:
We thank the MR CLEAN-MED and CONTRAST investigators for their contribution. A list of all investigators is given in the supplements.

Funding Information:
DD and AvdL report unrestricted grants from Stryker, Penumbra, Medtronic, Cerenovus, Thrombolytic Science, LLC, Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organization for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and Thrombolytic Science, LLC for research, paid to institution. BR reports funding from the Dutch Heart Foundation and the Netherlands Organization of Health Research and Development, paid to institution. WvZ chairs DSMBs of WETRUST, Solonda and InExtremis studies, and received speaker fees from Stryker, Cerenovus and NicoLab, all paid to institution. CM reports grants from CVON/Dutch Heart Foundation, TWIN Foundation, European Commission, Healthcare Evaluation Netherlands, and Stryker (paid to institution); and is (minority interest) shareholder of NicoLab. RvdB reports consultancy agreements for Cerenovus, the steering committee of the SPERO trial, and educational activities. WvdS, MvdS, RvdG, RS, LW, HvV, HdH, PJvD, AvE, JS and HL report no conflict of interest.

Publisher Copyright:
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