{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:59:02Z","timestamp":1781186342808,"version":"3.54.1"},"reference-count":21,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2017,10,8]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The use of periprocedural heparin has previously been reported to be safe and potentially beneficial during thrombectomy with older generation devices. We aimed to evaluate the safety and clinical outcomes of heparin use in the stent retriever era.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A post hoc analysis of the TREVO 2 trial was performed comparing baseline characteristics and clinical outcomes between patients who received (HEP+) and those who did not receive periprocedural heparin (HEP\u2212) while undergoing MERCI or TREVO clot retrieval.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 173 patients, 58 (34%) received periprocedural heparin including 40 who received one preprocedural bolus (median 3000 units). Baseline characteristics among HEP+ and\u2009HEP\u2212 patients were similar except HEP+ patients had\u2009a lower NIH Stroke Scale (NIHSS) score (17 vs 19; p=0.04), lower IV tissue plasminogen activator use (38% vs 64%; p&lt;0.01), and a higher median ASPECTS score (8.0 vs 7.0; p=0.02). HEP+ patients were more likely to have vertebrobasilar and middle cerebral artery (MCA)-M1 occlusions but less likely to have internal carotid artery and MCA-M2 occlusions (p=0.04). Time from symptom onset to puncture was similar in the two groups while procedure duration was longer in HEP+ patients (99 vs 83\u2009min; p&lt;0.01). Thrombolysis In Cerebral Infarction (TICI) 2b\u20133 reperfusion rates, embolization to unaffected territories, access site complications, and intracranial hemorrhages were similar between the groups. In multivariable logistic regression, a good outcome (90-day modified Rankin Scale score 0\u20132) was independently associated with heparin bolus use (OR 5.30; 95%\u2009CI 1.70 to 16.48), TICI 2b\u20133 reperfusion (OR 6.56; 95%\u2009CI 2.29 to 18.83), stent retriever use (OR 3.54; 95%\u2009CI 1.38 to 9.03) and inversely associated with intubation (OR 0.10; 95%\u2009CI 0.03 to 0.33), diabetes (OR 0.11; 95%\u2009CI 0.03 to 0.39), NIHSS (OR 0.84; 95%\u2009CI 0.75 to 0.93), time from symptom onset to puncture (OR 0.64; 95%\u2009CI 0.45 to 0.89), and heart failure (OR 0.23; 95%\u2009CI 0.06 to 0.83).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The use of periprocedural heparin in stent retriever thrombectomy is associated with a good clinical outcome at 90 days and similar rates of symptomatic intracranial hemorrhage. Further studies are warranted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration<\/jats:title>\n                  <jats:p>URL:<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.clinicaltrials.gov\" ext-link-type=\"uri\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>. Unique identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT01270867\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial post-results\">NCT01270867<\/jats:ext-link>; Post-results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/neurintsurg-2017-013441","type":"journal-article","created":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T02:25:17Z","timestamp":1533090317000},"page":"611-614","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Periprocedural heparin use in acute ischemic stroke endovascular therapy: the TREVO 2 trial"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct01270867","registry":"10.18810\/clinical-trials-gov","type":"postResults"},{"clinical-trial-number":"nct01270867","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Melanie J","family":"Winningham","sequence":"first","affiliation":[{"name":"Department of Neurology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo C","family":"Haussen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neurosurgery, Radiology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neurosurgery, Radiology, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S","family":"Liebeskind","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California, Los Angeles, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wade S","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmi L","family":"Lutsep","sequence":"additional","affiliation":[{"name":"Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tudor G","family":"Jovin","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, ProSpect Analytical Technology, San Jose, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Nahab","sequence":"additional","affiliation":[{"name":"Department of Neurology and Pediatrics, Emory University, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,10,31]]},"reference":[{"key":"2025092911242124000_10.7.611.1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e318284056a"},{"key":"2025092911242124000_10.7.611.2","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.04.009","article-title":"Safety of periprocedural heparin in acute ischemic stroke endovascular therapy: the multi MERCI trial","volume":"21","author":"Nahab","year":"2012","journal-title":"J Stroke Cerebrovasc 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