Safety and Efficacy of Mechanical Thrombectomy in Acute Ischemic Stroke of Anticoagulated Patients—A Prospective Observational Study

Fernández, Lorena Benavente; Larrosa, Davinia; García-Cabo, Carmen; Perez, Angel; Rico, María; Vega, Pedro; Murias, Eduardo; Calleja, Sergio

doi:10.1016/j.jstrokecerebrovasdis.2016.06.006

Cited by 25 publications

(22 citation statements)

References 20 publications

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“…In accordance with other authors [12,13,24], rates of recanalization were similar between anticoagulated and non-anticoagulated patients. Furthermore, after 3 months of follow-up, no significant differences were observed in rates of mortality or independent outcome (mRS score ≤2) in anticoagulated patients compared to non-anticoagulated patients.…”

Section: Discussionsupporting

confidence: 93%

“…In their prospective observational study, Benavente et al [24] reported a non-significant twofold increase in the rate of sICH following endovascular thrombectomy in 30 anticoagulated patients on VKAs compared with 109 non-anticoagulated controls (16.66 vs. 8.23%, p = 0.169). No patient in the study received prior intravenous or intra-arterial thrombolysis.…”

Section: Discussionmentioning

confidence: 97%

“…To date, only one recently published study has provided evidence for the safety of mechanical thrombectomy in this specific patient group [24]. Other studies of anticoagulated patients involve patients irrespective of prior intravenous thrombolysis use, include a combination of intra-arterial thrombolysis and mechanical thrombectomy treatments, employ the use of first generation devices that have been shown to be inferior to newer stent retrievers [22], or lack an appropriate control group [23].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, after 3 months of follow-up, no significant differences were observed in rates of mortality or independent outcome (mRS score ≤2) in anticoagulated patients compared to non-anticoagulated patients. Benavente et al [24] reported a trend towards improved survival rates among anticoagulated patients following mechanical thrombectomy, while studies on mixed thrombectomy and thrombolysis cohorts have reported either a trend towards higher mortality rates [13] or no differences [12].…”

Section: Discussionmentioning

confidence: 99%

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Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis

et al. 2018

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Background/Aim: Endovascular thrombectomy may be performed in anticoagulated patients taking vitamin-K antagonists (VKA) or direct-acting oral anticoagulants (DOAC) in whom the use of intravenous tissue plasminogen activator (tPA) is contraindicated. We aimed to investigate the efficacy and safety of mechanical thrombectomy specifically in anticoagulated patients ineligible for thrombolysis. Methods: We performed a retrospective analysis of a prospectively collected database of consecutive ischaemic stroke patients undergoing mechanical thrombectomy from January 2008 to June 2017. Patients receiving any dose of intravenous or intra-arterial thrombolysis were excluded. Patients taking oral anticoagulants (VKAs or DOACs) were compared with non-anticoagulated patients. Outcomes compared between groups included the rate of intracerebral haemorrhage (ICH) on follow-up imaging (ICHany), symptomatic ICH, functional independence at 90 days (modified Rankin scale score, 0–2), mortality, and post-treatment recanalization (Thrombolysis in Cerebral Infarction score ≥2b). Results: In all, 102 patients undergoing mechanical thrombectomy without prior thrombolysis were included in the study. Sixty-six (64.7%) patients were not anticoagulated, 23 (22.5%) patients were taking VKAs, and 13 (12.7%) patients were taking DOACs. There were no significant differences in the rate of ICHany (11.1 vs. 13.6%, p = 0.93) or sICH (2.8 vs. 1.5%, p = 0.14) in anticoagulated patients compared to non-anticoagulated patients. No cases of sICH were observed among patients taking DOACs. After 90 days of follow-up, the rates of functional independence (50.0 vs. 43.1%) and mortality (27.8 vs. 25.8%) were also similar between the anticoagulation and the non-anticoagulation groups. Conclusion: Mechanical thrombectomy appears to be safe and effective in anticoagulated patients ineligible for thrombolysis, with observed haemorrhage rates similar to those of patients not on anticoagulant therapy. However, further multicentre prospective studies are needed, due to the rising number of patients on warfarin and DOACs worldwide.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Safety of Endovascular Thrombectomy for Acute Ischaemic Stroke in Anticoagulated Patients Ineligible for Intravenous Thrombolysis

et al. 2018

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show abstract

“…In our study, previous intravenous thrombolysis was performed in nearly 60% (n=233) of non-anticoagulated patients and in 15% (n=17) of anticoagulated patients. In their prospective observational study, Benavente et al 23 compared 30 anticoagulated patients and 109 non-anticoagulated patients who underwent primary mechanical thrombectomy. No patient received previous intravenous thrombolysis or treatment with DOACs.…”

Section: Discussionmentioning

confidence: 99%