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Original research
Safety and efficacy of mechanical thrombectomy in acute ischemic stroke of anticoagulated patients
  1. Vincent L’Allinec1,2,
  2. Marielle Ernst3,
  3. Mathieu Sevin-Allouet1,
  4. Nathalie Testard1,
  5. Béatrice Delasalle-Guyomarch4,
  6. Benoit Guillon1,
  7. Mikael Mazighi5,
  8. Hubert Desal2,
  9. Romain Bourcier2
  10. the NTF investigators
    1. 1Neurology Department, University of Nantes Hospital, Nantes, France
    2. 2Radiology Department, University of Nantes Hospital, Nantes, France
    3. 3Radiology Department, University of Hamburg-Eppendorf, Hamburg, Germany
    4. 4Cardiology Unit, Institut du Thorax, University of Nantes Hospital, Nantes, France
    5. 5Radiology Department, Fondation Rothschild Hospital, Paris, France
    1. Correspondence to Dr. Vincent L’Allinec, Neurology Department, University of Nantes Hospital, Nantes 44093, France; vincent.lallinec{at}gmail.com

    Abstract

    Background Anticoagulated patients (APs) are currently excluded from acute ischemic stroke reperfusion therapy with intravenous recombinant tissue plasminogen activator (IV-rtPA); however, these patients could benefit from mechanical thrombectomy (MT). Evidence for MT in this condition remains scarce. The aim of this study was to analyze the safety and efficacy of MT in APs.

    Methods We analyzed three patient groups from two prospective registries: APs with MT (AP-MT group), non-anticoagulated patients treated with MT (NAP-MT group), and non-anticoagulated patients treated with IV-rtPA and MT (NAP-IVTMT group). Univariate and multivariate logistic regression were used to evaluate treatment efficacy with modified Rankin Scale (mRS) ≤2 and safety (radiologic intracranial hemorrhage (rICH), symptomatic intracranial hemorrhage (sICH) and death rate at 3 months) between groups.

    Results 333 patients were included in the study, with 44 (12%) in the AP-MT group, 105 (31%) in the NAP-MT group, and 188 (57%) in the NAP-IVTMT group. Univariate analysis showed that the AP-MT group was older (P<0.001), more often had atrial fibrillation (P<0001), and had a higher ASPECTS (P<0.006 and P<0.002) compared with the NAP-MT group and NAP-IVTMT groups, respectively. Multivariate analysis showed that the AP-MT group had a lower risk of rICH (OR 2.77, 95% CI 1.01 to 7.61, P=0.05) but a higher risk of death at 3 months (OR 0.26, 95% CI 0.09 to 0.76, P=0.01) compared with the NAP-IVTMT group. No difference was found between the AP-MT and NAP-MT groups.

    Conclusions With regard to intracranial bleeding and functional outcome at 3 months, MT in APs seems as safe and efficient as in NAPs. However, there is a higher risk of death at 3 months in the AP-MT group compared with the NAP-IVTMT group.

    • stroke
    • mechanical thrombectomy
    • anticoagulant
    • safety

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    Footnotes

    • Contributors VLA had the concept of the study, collected data and wrote the manuscript. ME wrote and critically reviewed the manuscript, and corrected the spelling and grammar. MS-A collected data and critically reviewed the manuscript. NT collected data. BD-G performed the statistical analysis. BG, MM and HD critically reviewed the manuscript. RB wrote and critically reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was approved by the Institutional Review Board of Nantes University Hospital (no. RC17_0274) and by the Commission Nationale de l’Informatique et des Libertés (no. 2017-028).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Collaborators The NTF investigators : Bourcier Romain, Guillon Benoit, Gaultier Alina, Daumas-Duport Benjamin, Catar Oana, Lecluse Alderic, Godard Sophie, Marc Guillaume, Pasco Anne, Rouanet François, Sibon Igor, Barreau Xavier, Berge Jérome, Menegon Patrice, Doucet Vincent, Ferrier Anna, Jean Betty, Chabert Emmanuel, Gabrillarges Jean, Kazemi Apolline, Ricolfi Frederic, Tahon Florence, Vasdev Ashok, Boustia Fakhreddine, Kalsoum Erwah, Agettaz Pierre, Leclerc Xavier, Saleme Suzanna, Mounayer Charbel, Gautier Guillaume, Brunel Herve, Tonnelet Romain, Anxionnat Rene, Bracard Serge, Riquelme Carlos, Machi Paolo, Arquizan Caroline, Costalat Vincent, Bonafe Alain, Pierot Laurent, Ronziere Thomas, Gauvrit Jean-Yves, Januel Anne-Christine, Bonneville Fabrice, Cognard Christophe, Papagiannaki Chrysanthi, Bibi Richard, Herbreteau Denus, Naggara Olivier, Puccinelli Francesco, Mazighi Mikael, Lapergue Bertrand, Coskun Oguzhan, Guedin Pierre, Rodesch Georges, Hosseini Hassan, Tulier Titien, Gallas Sophie, Gaston Andre, Blanc Raphael, Piotin Michel, Gory Benjamin, Riva Roberto, Valesco Stephane.

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