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Periprocedural Heparin During Endovascular Treatment of Tandem Lesions in Patients with Acute Ischemic Stroke: A Propensity Score Analysis from TITAN Registry

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  • François Zhu
  • Michel Piotin
  • Henrik Steglich-Arnholm
  • Julien Labreuche
  • Markus Holtmannspötter
  • Christian Taschner
  • Sebastian Eiden
  • Diogo C Haussen
  • Raul G Nogueira
  • Panagiotis Papanagiotou
  • Maria Boutchakova
  • Adnan H Siddiqui
  • Bertrand Lapergue
  • Franziska Dorn
  • Christophe Cognard
  • Monika Killer-Oberpfalzer
  • Salvatore Mangiafico
  • Marc Ribo
  • Marios N Psychogios
  • Alejandro Spiotta
  • Mohammad Anadani
  • Marc-Antoine Labeyrie
  • Mikael Mazighi
  • Alessandra Biondi
  • Sébastien Richard
  • René Anxionnat
  • Serge Bracard
  • Francis Turjman
  • Benjamin Gory
  • TITAN (Thrombectomy In TANdem Lesions) Investigators
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BACKGROUND AND PURPOSE: Data on safety and efficacy of periprocedural use of heparin are limited during treatment of acute ischemic stroke patients with anterior circulation tandem occlusion. This study aimed to investigate the impact of heparin use during endovascular therapy of anterior circulation tandem occlusions on the functional and safety outcomes.

METHODS: A retrospective analysis of the multicenter observational TITAN registry was performed. Patients with anterior circulation tandem occlusion and treated with endovascular therapy (EVT) were included, with or without extracranial carotid intervention. We divided patients into two groups based on periprocedural heparin use (heparin vs. non-heparin). The dose of intravenous unfractionated heparin ranged from 1500 to 2500 I.U. Primary study endpoint was 90-day Modified Rankin Scale (mRS). Secondary study endpoint included angiographic and safety endpoints such as hemorrhagic complications. A propensity-score-matched analysis was performed.

RESULTS: Among 369 patients, heparin was used in 68 patients (18.4%). In the propensity-score-matched cohort, favorable outcome (mRS 0-2) occurred in 51.3% in heparin group and 58.0% in non-heparin group (matched OR, 0.76; 95% CI, 0.32-1.78; P = 0.52). Similar result was found in propensity-score-adjusted cohort (adjusted OR, 0.72; 95%CI, 0.39-1.32; P = 0.28). Likewise, there was no difference in the rate of successful reperfusion (mTICI 2b-3) (propensity-score-adjusted OR, 1.03; 95%CI, 0.50-2.09; P = 0.93) neither in safety endpoints between the two groups.

CONCLUSIONS: Periprocedural heparin use during EVT of anterior circulation tandem occlusions was not associated with better functional, angiographic or safety outcomes. These findings are applicable for low doses of heparin, and further studies are warranted.

Original languageEnglish
JournalCardiovascular and Interventional Radiology
Volume42
Issue number8
Pages (from-to)1160-1167
Number of pages8
ISSN0174-1551
DOIs
Publication statusPublished - Aug 2019

ID: 58224638