{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T05:23:27Z","timestamp":1732685007643,"version":"3.28.2"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The benefit-to-risk ratio of periprocedural heparin in patients treated with endovascular thrombectomy (EVT) after intravenous thrombolysis (IVT) remains unclear. This study aimed to evaluate the potential effects of periprocedural heparin on clinical outcomes of EVT after IVT.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively analyzed patients from multicenter studies treated with EVT after IVT in the anterior circulation. The endpoints were unfavorable outcome (defined as modified Rankin Scale score \u2265 3 at 90 days), 90-day mortality, symptomatic intracranial hemorrhage (SICH), successful recanalization, and early neurological deterioration. Patients were divided into two groups based on whether they were treated with heparin (heparin-treated group) or not (untreated group), and the efficacy and safety outcomes were compared using multivariable logistic regression models and propensity score\u2013matching methods.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Among the 322 included patients (mean age 67.4 years, 54.3% male), 32% of patients received periprocedural heparin. In multivariable analyses, the administration of periprocedural heparin was a significant predictor for unfavorable outcome (OR 2.821, 95% CI 1.15\u20137.326; p = 0.027), SICH (OR 24.925, 95% CI 2.363\u2013780.262; p = 0.025), and early neurological deterioration (OR 5.344, 95% CI 1.299\u201328.040; p = 0.029). Regarding successful recanalization and death, no significant differences between the groups were found after propensity score matching.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The results showed that periprocedural heparin is associated with an increased risk of unfavorable outcomes and SICH in patients treated with EVT after IVT. Further studies are warranted to evaluate the utility and safety of periprocedural heparin.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.1.jns232584","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T16:56:12Z","timestamp":1713286572000},"page":"355-361","source":"Crossref","is-referenced-by-count":0,"title":["Periprocedural intravenous heparin in patients with acute ischemic stroke treated with endovascular thrombectomy after intravenous thrombolysis"],"prefix":"10.3171","volume":"141","author":[{"given":"Hao","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology, Linyi People\u2019s Hospital, Affiliated Hospital of Weifang Medical College, Shandong;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kang","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianjun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Longhua People\u2019s Hospital, Southern Medical University (Longhua People\u2019s Hospital), Shenzhen; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengdi","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Nanjing Medical School, Nanjing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruidong","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunfei","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiushi","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingshi","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Affiliated Longhua People\u2019s Hospital, Southern Medical University (Longhua People\u2019s Hospital), Shenzhen; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10029","key":"b1","series-title":"Lancet","first-page":"1723","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal M","year":"2016","unstructured":"Goyal M, Menon BK, van Zwam WH,  Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723\u20131731."},{"issue":"8","key":"b2","series-title":"N Engl J Med","first-page":"708","article-title":"Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging","volume":"378","author":"Albers GW","year":"2018","unstructured":"Albers GW, Marks MP, Kemp S,  Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708\u2013718."},{"issue":"24","key":"b3","series-title":"N Engl J Med","first-page":"2296","article-title":"Thrombectomy within 8 hours after symptom onset in ischemic stroke","volume":"372","author":"Jovin TG","year":"2015","unstructured":"Jovin TG, Chamorro A, Cobo E,  Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296\u20132306."},{"issue":"1","key":"b4","series-title":"N Engl J Med","first-page":"11","article-title":"Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct","volume":"378","author":"Nogueira RG","year":"2018","unstructured":"Nogueira RG, Jadhav AP, Haussen DC,  Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11\u201321."},{"issue":"1","key":"b5","series-title":"Eur J Neurol","first-page":"141","article-title":"Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy","volume":"28","author":"Riou-Comte N","year":"2021","unstructured":"Riou-Comte N, Guillemin F, Gory B,  Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy. Eur J Neurol. 2021;28(1):141\u2013151."},{"issue":"1","key":"b6","series-title":"Sci Rep","first-page":"2173","article-title":"Endovascular procedures cause transient endothelial injury but do not disrupt mature neointima in drug eluting stents","volume":"10","author":"Autar A","year":"2020","unstructured":"Autar A, Taha A, van Duin R,  Endovascular procedures cause transient endothelial injury but do not disrupt mature neointima in drug eluting stents. Sci Rep. 2020;10(1):2173."},{"issue":"2","key":"b7","series-title":"Ann Neurol","first-page":"223","article-title":"Neutrophil extracellular traps in ischemic stroke thrombi","volume":"82","author":"Laridan E","year":"2017","unstructured":"Laridan E, Denorme F, Desender L,  Neutrophil extracellular traps in ischemic stroke thrombi. Ann Neurol. 2017;82(2):223\u2013232."},{"key":"b8","series-title":"Front Neurol","first-page":"299","article-title":"Safety and efficacy of heparinization during mechanical thrombectomy in acute ischemic stroke","volume":"10","author":"Yang M","year":"2019","unstructured":"Yang M, Huo X, Gao F,  Safety and efficacy of heparinization during mechanical thrombectomy in acute ischemic stroke. Front Neurol. 2019;10:299."},{"key":"b9","series-title":"Front Neurol","first-page":"238","article-title":"Periprocedural antithrombotic treatment during acute mechanical thrombectomy for ischemic stroke: a systematic review","volume":"9","author":"van de Graaf RA","year":"2018","unstructured":"van de Graaf RA, Chalos V, Del Zoppo GJ, van der Lugt A, Dippel DWJ, Roozenbeek B. Periprocedural antithrombotic treatment during acute mechanical thrombectomy for ischemic stroke: a systematic review. Front Neurol. 2018;9:238."},{"issue":"10","key":"b10","series-title":"J Stroke Cerebrovasc Dis","first-page":"106726","article-title":"Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment","volume":"31","author":"van der Steen W","year":"2022","unstructured":"van der Steen W, van der Sluijs PM, van de Graaf RA,  Safety and efficacy of periprocedural antithrombotics in patients with successful reperfusion after endovascular stroke treatment. J Stroke Cerebrovasc Dis. 2022;31(10):106726."},{"issue":"6","key":"b11","series-title":"J Neuroradiol","first-page":"373","article-title":"Heparin during endovascular stroke treatment seems safe","volume":"46","author":"Sallustio F","year":"2019","unstructured":"Sallustio F, Motta C, Merolla S,  Heparin during endovascular stroke treatment seems safe. J Neuroradiol. 2019;46(6):373\u2013377."},{"issue":"7","key":"b12","series-title":"J Neurointerv Surg","first-page":"611","article-title":"Periprocedural heparin use in acute ischemic stroke endovascular therapy: the TREVO 2 trial","volume":"10","author":"Winningham MJ","year":"2018","unstructured":"Winningham MJ, Haussen DC, Nogueira RG,  Periprocedural heparin use in acute ischemic stroke endovascular therapy: the TREVO 2 trial. J Neurointerv Surg. 2018;10(7):611\u2013614."},{"issue":"10329","key":"b13","series-title":"Lancet","first-page":"1059","article-title":"Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial","volume":"399","author":"van der Steen W","year":"2022","unstructured":"van der Steen W, van de Graaf RA, Chalos V,  Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial. Lancet. 2022;399(10329):1059\u20131069."},{"issue":"6","key":"b14","series-title":"Int J Stroke","first-page":"621","article-title":"Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke: a meta-analysis of randomized controlled trials","volume":"16","author":"Podlasek A","year":"2021","unstructured":"Podlasek A, Dhillon PS, Butt W, Grunwald IQ, England TJ. Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke: a meta-analysis of randomized controlled trials. Int J Stroke. 2021;16(6):621\u2013631."},{"issue":"13","key":"b15","series-title":"N Engl J Med.","first-page":"1317","article-title":"Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke","volume":"359","author":"Hacke W","year":"2008","unstructured":"Hacke W, Kaste M, Bluhmki E,   Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med.  2008;359(13):1317\u20131329."},{"issue":"1","key":"b16","series-title":"TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke.","first-page":"35","article-title":"Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial","volume":"24","author":"Adams HP Jr","year":"1993","unstructured":"Adams HP Jr, Bendixen BH, Kappelle LJ,  Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke.1993;24(1):35\u201341."},{"issue":"2","key":"b17","series-title":"ESC\/EACTS Guidelines on Myocardial Revascularization. Eur Heart J","first-page":"79","article-title":"\u2018Ten commandments\u2019 for the 2018","volume":"40","author":"Neumann FJ","year":"2019","unstructured":"Neumann FJ, Sousa-Uva M. \u2018Ten commandments\u2019 for the 2018. ESC\/EACTS Guidelines on Myocardial Revascularization. Eur Heart J. 2019;40(2):79\u201380."},{"issue":"8","key":"b18","series-title":"J Stroke Cerebrovasc Dis","first-page":"790","article-title":"Safety of periprocedural heparin in acute ischemic stroke endovascular therapy: the Multi MERCI trial","volume":"21","author":"Nahab F","year":"2012","unstructured":"Nahab F, Walker GA, Dion JE, Smith WS. Safety of periprocedural heparin in acute ischemic stroke endovascular therapy: the Multi MERCI trial. J Stroke Cerebrovasc Dis. 2012;21(8):790\u2013793."},{"issue":"8","key":"b19","series-title":"Stroke","first-page":"2147","article-title":"Periprocedural intravenous heparin during endovascular treatment for ischemic stroke: results from the MR CLEAN Registry","volume":"50","author":"van de Graaf RA","year":"2019","unstructured":"van de Graaf RA, Chalos V, van Es ACGM,  Periprocedural intravenous heparin during endovascular treatment for ischemic stroke: results from the MR CLEAN Registry. Stroke. 2019;50(8):2147\u20132155."},{"issue":"10406","key":"b20","series-title":"Lancet","first-page":"965","article-title":"Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials","volume":"402","author":"Majoie CB","year":"2023","unstructured":"Majoie CB, Cavalcante F, Gralla J, Yang P, Kaesmacher J, Treurniet KM. et al.Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet. 2023;402(10406):965\u2013974."},{"issue":"5","key":"b21","series-title":"Eur J Neurol","first-page":"1312","article-title":"Intravenous thrombolysis + endovascular thrombectomy versus thrombolysis alone in large vessel occlusion mild stroke: a propensity score matched analysis","volume":"30","author":"Schwarz G","year":"2023","unstructured":"Schwarz G, Bonato S, Lanfranconi S,  Intravenous thrombolysis + endovascular thrombectomy versus thrombolysis alone in large vessel occlusion mild stroke: a propensity score matched analysis. Eur J Neurol. 2023;30(5):1312\u20131319."},{"issue":"9958","key":"b22","series-title":"Lancet","first-page":"1929","article-title":"Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials","volume":"384","author":"Emberson J","year":"2014","unstructured":"Emberson J, Lees KR, Lyden P,  Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929\u20131935."},{"issue":"5","key":"b23","series-title":"AJNR Am J Neuroradiol","first-page":"991","article-title":"Risk of thrombus fragmentation during endovascular stroke treatment","volume":"38","author":"Kaesmacher J","year":"2017","unstructured":"Kaesmacher J, Boeckh-Behrens T, Simon S,  Risk of thrombus fragmentation during endovascular stroke treatment. AJNR Am J Neuroradiol. 2017;38(5):991\u2013998."},{"key":"b24","series-title":"J Neurointerv Surg. Published online July","article-title":"Periprocedural unfractionated heparin bolus during endovascular treatment in acute ischemic stroke does more harm than good","volume":"26,","author":"Wischmann J","year":"2023","unstructured":"Wischmann J, Masouris I, Keidel L, Tiedt S, Trumm CG, Zimmermann H,  Periprocedural unfractionated heparin bolus during endovascular treatment in acute ischemic stroke does more harm than good. J Neurointerv Surg. Published online July 26,2023. doi:10.1136\/jnis-2023-020551"},{"issue":"12","key":"b25","series-title":"Stroke","first-page":"3536","article-title":"Endovascular treatment for acute ischemic stroke in the setting of anticoagulation","volume":"46","author":"Rebello LC","year":"2015","unstructured":"Rebello LC, Haussen DC, Belagaje S, Anderson A, Frankel M, Nogueira RG. Endovascular treatment for acute ischemic stroke in the setting of anticoagulation. Stroke. 2015;46(12):3536\u20133539."},{"issue":"8","key":"b26","series-title":"Cardiovasc Intervent Radiol","first-page":"1160","article-title":"Periprocedural heparin during endovascular treatment of tandem lesions in patients with acute ischemic stroke: a propensity score analysis from TITAN Registry","volume":"42","author":"Zhu F","year":"2019","unstructured":"Zhu F, Piotin M, Steglich-Arnholm H,  Periprocedural heparin during endovascular treatment of tandem lesions in patients with acute ischemic stroke: a propensity score analysis from TITAN Registry. Cardiovasc Intervent Radiol. 2019;42(8):1160\u20131167."},{"key":"b27","series-title":"Stroke","first-page":"e364","article-title":"2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association","volume":"52","author":"Kleindorfer DO","year":"2021","unstructured":"Kleindorfer DO, Towfighi A, Chaturvedi S,  2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association\/American Stroke Association. Stroke. 2021;52:e364\u2013e467."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/2\/article-p355.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/2\/article-p355.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/2\/article-p355.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T11:44:19Z","timestamp":1732621459000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/2\/article-p355.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":27,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2024.1.jns232584","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"type":"print","value":"0022-3085"},{"type":"electronic","value":"1933-0693"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}