Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke : Results From the MR CLEAN Registry
Background and Purpose- Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use in Dutch stroke intervention centers and to assess its efficacy and safety. Methods- Patients registered between March 2014 and June 2016 in the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke), including all patients treated with endovascular treatment in the Netherlands, were analyzed. The primary outcome was functional outcome (modified Rankin Scale) at 90 days. Secondary outcomes were successful recanalization (extended Thrombolysis in Cerebral Infarction ≥2B), symptomatic intracranial hemorrhage, and mortality at 90 days. We used multilevel regression analysis to evaluate the association of periprocedural intravenous heparin on outcomes, adjusted for center effects and prognostic factors. To account for possible unobserved confounding by indication, we analyzed the effect of center preference to administer intravenous heparin, defined as percentage of patients treated with intravenous heparin in a center, on functional outcome. Results- One thousand four hundred eighty-eight patients from 16 centers were analyzed, of whom 398 (27%) received intravenous heparin (median dose 5000 international units). There was substantial between-center variability in the proportion of patients treated with intravenous heparin (range, 0%-94%). There was no significant difference in functional outcome between patients treated with intravenous heparin and those without (adjusted common odds ratio, 1.17; 95% CI, 0.87-1.56), successful recanalization (adjusted odds ratio, 1.24; 95% CI, 0.89-1.71), symptomatic intracranial hemorrhage (adjusted odds ratio, 1.13; 95% CI, 0.65-1.99), or mortality (adjusted odds ratio, 0.95; 95% CI, 0.66-1.38). Analysis at center level showed that functional outcomes were better in centers with higher percentages of heparin administration (adjusted common odds ratio, 1.07 per 10% more heparin, 95% CI, 1.01-1.13). Conclusions- Substantial between-center variability exists in periprocedural intravenous heparin use during endovascular treatment, but the treatment is safe. Centers using heparin more often had better outcomes. A randomized trial is needed to further study these effects.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:50 |
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| Enthalten in: |
Stroke - 50(2019), 8 vom: 02. Aug., Seite 2147-2155 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van de Graaf, Rob A [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 09.03.2020 Date Revised 09.03.2020 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1161/STROKEAHA.119.025329 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM304609269 |
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| 100 | 1 | |a van de Graaf, Rob A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Periprocedural Intravenous Heparin During Endovascular Treatment for Ischemic Stroke |b Results From the MR CLEAN Registry |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 09.03.2020 | ||
| 500 | |a Date Revised 09.03.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Background and Purpose- Intravenous administration of heparin during endovascular treatment for ischemic stroke may improve outcomes. However, risks and benefits of this adjunctive therapy remain uncertain. We aimed to evaluate periprocedural intravenous heparin use in Dutch stroke intervention centers and to assess its efficacy and safety. Methods- Patients registered between March 2014 and June 2016 in the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke), including all patients treated with endovascular treatment in the Netherlands, were analyzed. The primary outcome was functional outcome (modified Rankin Scale) at 90 days. Secondary outcomes were successful recanalization (extended Thrombolysis in Cerebral Infarction ≥2B), symptomatic intracranial hemorrhage, and mortality at 90 days. We used multilevel regression analysis to evaluate the association of periprocedural intravenous heparin on outcomes, adjusted for center effects and prognostic factors. To account for possible unobserved confounding by indication, we analyzed the effect of center preference to administer intravenous heparin, defined as percentage of patients treated with intravenous heparin in a center, on functional outcome. Results- One thousand four hundred eighty-eight patients from 16 centers were analyzed, of whom 398 (27%) received intravenous heparin (median dose 5000 international units). There was substantial between-center variability in the proportion of patients treated with intravenous heparin (range, 0%-94%). There was no significant difference in functional outcome between patients treated with intravenous heparin and those without (adjusted common odds ratio, 1.17; 95% CI, 0.87-1.56), successful recanalization (adjusted odds ratio, 1.24; 95% CI, 0.89-1.71), symptomatic intracranial hemorrhage (adjusted odds ratio, 1.13; 95% CI, 0.65-1.99), or mortality (adjusted odds ratio, 0.95; 95% CI, 0.66-1.38). Analysis at center level showed that functional outcomes were better in centers with higher percentages of heparin administration (adjusted common odds ratio, 1.07 per 10% more heparin, 95% CI, 1.01-1.13). Conclusions- Substantial between-center variability exists in periprocedural intravenous heparin use during endovascular treatment, but the treatment is safe. Centers using heparin more often had better outcomes. A randomized trial is needed to further study these effects | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a cerebral infarction | |
| 650 | 4 | |a heparin | |
| 650 | 4 | |a reperfusion | |
| 650 | 4 | |a stroke | |
| 650 | 4 | |a thrombectomy | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 650 | 7 | |a Recombinant Proteins |2 NLM | |
| 650 | 7 | |a Heparin |2 NLM | |
| 650 | 7 | |a 9005-49-6 |2 NLM | |
| 650 | 7 | |a Urokinase-Type Plasminogen Activator |2 NLM | |
| 650 | 7 | |a EC 3.4.21.73 |2 NLM | |
| 650 | 7 | |a saruplase |2 NLM | |
| 650 | 7 | |a U5NH2JV64T |2 NLM | |
| 700 | 1 | |a Chalos, Vicky |e verfasserin |4 aut | |
| 700 | 1 | |a van Es, Adriaan C G M |e verfasserin |4 aut | |
| 700 | 1 | |a Emmer, Bart J |e verfasserin |4 aut | |
| 700 | 1 | |a Lycklama À Nijeholt, Geert J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Worp, H Bart |e verfasserin |4 aut | |
| 700 | 1 | |a Schonewille, Wouter J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Lugt, Aad |e verfasserin |4 aut | |
| 700 | 1 | |a Dippel, Diederik W J |e verfasserin |4 aut | |
| 700 | 1 | |a Lingsma, Hester F |e verfasserin |4 aut | |
| 700 | 1 | |a Roozenbeek, Bob |e verfasserin |4 aut | |
| 700 | 0 | |a Coinvestigators MR CLEAN Registry |e verfasserin |4 aut | |
| 700 | 1 | |a Majoie, Charles |e investigator |4 oth | |
| 700 | 1 | |a Roos, Yvo |e investigator |4 oth | |
| 700 | 1 | |a van Oostenbrugge, Robert |e investigator |4 oth | |
| 700 | 1 | |a van Zwam, Wim |e investigator |4 oth | |
| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a Albert Vos, Jan |e investigator |4 oth | |
| 700 | 1 | |a Jansen, Ivo |e investigator |4 oth | |
| 700 | 1 | |a Mulder, Maxim |e investigator |4 oth | |
| 700 | 1 | |a Goldhoorn, Robert-Jan |e investigator |4 oth | |
| 700 | 1 | |a Compagne, Kars |e investigator |4 oth | |
| 700 | 1 | |a Kappelhof, Manon |e investigator |4 oth | |
| 700 | 1 | |a Albert Vos, Jan |e investigator |4 oth | |
| 700 | 1 | |a Majoie, Charles |e investigator |4 oth | |
| 700 | 1 | |a Coutinho, Jonathan |e investigator |4 oth | |
| 700 | 1 | |a Wermer, Marieke |e investigator |4 oth | |
| 700 | 1 | |a van Walderveen, Marianne |e investigator |4 oth | |
| 700 | 1 | |a Staals, Julie |e investigator |4 oth | |
| 700 | 1 | |a van Zwam, Wim |e investigator |4 oth | |
| 700 | 1 | |a Hofmeijer, Jeannette |e investigator |4 oth | |
| 700 | 1 | |a Martens, Jasper M |e investigator |4 oth | |
| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a de Bruijn, Sebastiaan |e investigator |4 oth | |
| 700 | 1 | |a van Dijk, Lukas |e investigator |4 oth | |
| 700 | 1 | |a Lo, Rob |e investigator |4 oth | |
| 700 | 1 | |a van Dijk, Ewoud |e investigator |4 oth | |
| 700 | 1 | |a Boogaarts, Hieronymus |e investigator |4 oth | |
| 700 | 1 | |a de Kort, Paul |e investigator |4 oth | |
| 700 | 1 | |a Peluso, Jo |e investigator |4 oth | |
| 700 | 1 | |a van den Berg, Jan |e investigator |4 oth | |
| 700 | 1 | |a van Hasselt, Boudewijn |e investigator |4 oth | |
| 700 | 1 | |a Aerden, Leo |e investigator |4 oth | |
| 700 | 1 | |a Dallinga, René |e investigator |4 oth | |
| 700 | 1 | |a Uyttenboogaart, Maarten |e investigator |4 oth | |
| 700 | 1 | |a Eshghi, Omid |e investigator |4 oth | |
| 700 | 1 | |a Schreuder, Tobien |e investigator |4 oth | |
| 700 | 1 | |a Heijboer, Roel |e investigator |4 oth | |
| 700 | 1 | |a Keizer, Koos |e investigator |4 oth | |
| 700 | 1 | |a Yo, Lonneke |e investigator |4 oth | |
| 700 | 1 | |a den Hertog, Heleen |e investigator |4 oth | |
| 700 | 1 | |a Sturm, Emiel |e investigator |4 oth | |
| 700 | 1 | |a Majoie, Charles |e investigator |4 oth | |
| 700 | 1 | |a van Zwam, Wim |e investigator |4 oth | |
| 700 | 1 | |a van Walderveen, Marianne |e investigator |4 oth | |
| 700 | 1 | |a Sprengers, Marieke |e investigator |4 oth | |
| 700 | 1 | |a Jenniskens, Sjoerd |e investigator |4 oth | |
| 700 | 1 | |a van den Berg, René |e investigator |4 oth | |
| 700 | 1 | |a Yoo, Albert |e investigator |4 oth | |
| 700 | 1 | |a Beenen, Ludo |e investigator |4 oth | |
| 700 | 1 | |a Postma, Alida |e investigator |4 oth | |
| 700 | 1 | |a Roosendaal, Stefan |e investigator |4 oth | |
| 700 | 1 | |a van der Kallen, Bas |e investigator |4 oth | |
| 700 | 1 | |a van den Wijngaard, Ido |e investigator |4 oth | |
| 700 | 1 | |a Emmer, Bart |e investigator |4 oth | |
| 700 | 1 | |a Martens, Jasper |e investigator |4 oth | |
| 700 | 1 | |a Yo, Lonneke |e investigator |4 oth | |
| 700 | 1 | |a Albert Vos, Jan |e investigator |4 oth | |
| 700 | 1 | |a Bot, Joost |e investigator |4 oth | |
| 700 | 1 | |a van Doormaal, Pieter-Jan |e investigator |4 oth | |
| 700 | 1 | |a Majoie, Charles |e investigator |4 oth | |
| 700 | 1 | |a Roos, Yvo |e investigator |4 oth | |
| 700 | 1 | |a van Oostenbrugge, Robert |e investigator |4 oth | |
| 700 | 1 | |a van Zwam, Wim |e investigator |4 oth | |
| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a Albert Vos, Jan |e investigator |4 oth | |
| 700 | 1 | |a Hofmeijer, Jeannette |e investigator |4 oth | |
| 700 | 1 | |a Martens, Jasper |e investigator |4 oth | |
| 700 | 1 | |a Lo, Rob |e investigator |4 oth | |
| 700 | 1 | |a van Oostenbrugge, Robert |e investigator |4 oth | |
| 700 | 1 | |a Hofmeijer, Jeannette |e investigator |4 oth | |
| 700 | 1 | |a Flach, Zwenneke |e investigator |4 oth | |
| 700 | 1 | |a Ghannouti, Naziha El |e investigator |4 oth | |
| 700 | 1 | |a Sterrenberg, Martin |e investigator |4 oth | |
| 700 | 1 | |a Puppels, Corina |e investigator |4 oth | |
| 700 | 1 | |a Pellikaan, Wilma |e investigator |4 oth | |
| 700 | 1 | |a Sprengers, Rita |e investigator |4 oth | |
| 700 | 1 | |a Elfrink, Marjan |e investigator |4 oth | |
| 700 | 1 | |a de Meris, Joke |e investigator |4 oth | |
| 700 | 1 | |a Vermeulen, Tamara |e investigator |4 oth | |
| 700 | 1 | |a Geerlings, Annet |e investigator |4 oth | |
| 700 | 1 | |a van Vemde, Gina |e investigator |4 oth | |
| 700 | 1 | |a Simons, Tiny |e investigator |4 oth | |
| 700 | 1 | |a van Rijswijk, Cathelijn |e investigator |4 oth | |
| 700 | 1 | |a Messchendorp, Gert |e investigator |4 oth | |
| 700 | 1 | |a Bongenaar, Hester |e investigator |4 oth | |
| 700 | 1 | |a Bodde, Karin |e investigator |4 oth | |
| 700 | 1 | |a Kleijn, Sandra |e investigator |4 oth | |
| 700 | 1 | |a Lodico, Jasmijn |e investigator |4 oth | |
| 700 | 1 | |a Droste, Hanneke |e investigator |4 oth | |
| 700 | 1 | |a Wollaert, M |e investigator |4 oth | |
| 700 | 1 | |a Jeurrissen, D |e investigator |4 oth | |
| 700 | 1 | |a Bos, Ernas |e investigator |4 oth | |
| 700 | 1 | |a Drabbe, Yvonne |e investigator |4 oth | |
| 700 | 1 | |a Aaldering, Nicoline |e investigator |4 oth | |
| 700 | 1 | |a Zweedijk, Berber |e investigator |4 oth | |
| 700 | 1 | |a Khalilzada, Mostafa |e investigator |4 oth | |
| 700 | 1 | |a Venema, Esmee |e investigator |4 oth | |
| 700 | 1 | |a Geuskens, Ralph |e investigator |4 oth | |
| 700 | 1 | |a van Straaten, Tim |e investigator |4 oth | |
| 700 | 1 | |a Ergezen, Saliha |e investigator |4 oth | |
| 700 | 1 | |a Harmsma, Roger |e investigator |4 oth | |
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