Key result
Elevated admission INR is linked to ~78% higher 90-day mortality after EVT for LVO stroke.
Why the study?
The study was conducted to assess the relationship between the INR and clinical outcomes in patients with large vessel occlusion stroke who received endovascular therapy.
Does an elevated INR increase the risk of intracranial hemorrhage and 90-day mortality in patients with large vessel occlusion stroke undergoing endovascular treatment?
Observational (n=885)
Yes
Does an elevated INR increase the risk of intracranial hemorrhage and 90-day mortality in patients with large vessel occlusion stroke undergoing endovascular treatment?
In patients with large vessel occlusion stroke undergoing endovascular treatment, an elevated admission INR is associated with an increased risk of intracranial hemorrhage and 90-day mortality.
Elevated admission INR signals higher post-EVT mortality risk; leaves open whether INR correction improves outcomes in LVO stroke.
INTRODUCTION: The international normalized ratio (INR) is a biomarker of coagulopathy. The objective of this study was to assess the relationship between the INR and clinical outcomes in patients with large vessel occlusion (LVO) stroke who received endovascular therapy. METHODS: The RESCUE BT trial was a multicenter, randomized, double-blind, placebo-controlled clinical trial involving 948 stroke patients from 55 centers across China. We extracted INR data and related data from the BT database, with outcome measures comprising intracranial hemorrhage (ICH) and 90-day mortality. Logistic regression analysis was conducted to examine the associations between the INR and clinical outcomes in the entire patient cohort and across different stratified subgroups. RESULTS: A total of 885 patients met the study criteria, with 672 exhibiting a normal INR and 213 showing an elevated INR. Multivariable analysis indicated that an elevated INR was linked to an increased risk of ICH (OR 1.65, 95% confidence interval CI 1.17-2.33, P =0.005) and 90-day mortality (OR 1.78, 95% CI 1.17-2.70, P =0.007). Mediation analysis indicated that the association between the INR and 90-day mortality risk was partially mediated by ICH status, with the mediation effect contributing 11.4% to the overall relationship. Subgroup analyses revealed no significant differences between the different subgroups (P for interaction > 0.05). In patients receiving tirofiban, an elevated INR was more strongly associated with an increased 90-day mortality rate (OR 7.75, 95% CI 1.42-42.33, P =0.018). CONCLUSION: Our findings underscore the critical importance of INR monitoring in patients with LVO stroke undergoing endovascular treatment (EVT). The association between the INR and 90-day mortality was mediated through ICH status. The use of tirofiban strengthened the associated between an elevated INR and a higher 90-day mortality rate. These insights offer valuable guidance for optimizing patient outcomes. TRIAL REGISTRATION: URL: http://www.chictr.org.cn ; ChiCTR-INR-17014167.
No takes yet. Share an insight, caveat, or question.
Guo et al. (2025) conducted an observational in Large vessel occlusion (LVO) ischemic stroke (n=885). Elevated INR (> 1.1) vs. Normal INR (0.8-1.1) was evaluated on 90-day all-cause mortality (OR 1.78, 95% CI 1.17-2.70, p=0.007). In patients with large vessel occlusion stroke undergoing endovascular treatment, an elevated admission INR (>1.1) was significantly associated with an increased risk of 90-day mortality (OR 1.78).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: