Patients with abnormal hemostasis undergoing endovascular thrombectomy had similar rates of symptomatic intracranial hemorrhage (8.6% vs 8.5%) but lower rates of good clinical outcomes (9% vs 35%; P=0.002).
Cohort (n=305)
Yes
Does endovascular thrombectomy have similar safety and efficacy in stroke patients with abnormal hemostasis compared to those with normal hemostasis?
Endovascular thrombectomy in stroke patients with abnormal hemostasis does not increase the risk of symptomatic intracranial hemorrhage compared to those with normal hemostasis, though overall clinical outcomes are poorer likely due to lower baseline health status.
Absolute Event Rate: 9% vs 35%
p-value: p=0.002
BACKGROUND AND PURPOSE: Patients with abnormal hemostasis are not considered candidates for thrombolysis. We analyzed the MERCI/Multi MERCI cohort as an attempt to establish the risks and benefits of thrombectomy in this patient population. METHODS: Two patient groups were identified: Group 1 (n=35): patients with INR >1.7 or PTT >45 seconds or platelet count or=100,000/microL. Clinical, radiographic, and revascularization outcomes were subsequently compared. RESULTS: In Group 1, 20 patients had INR >1.7 (mean: 2.4; range: 1.8 to 4.9), 11 had PTT >45 seconds (mean: 95; range: 46 to 190), and 6 had platelets 1.7 and PTT >45 seconds. The two groups did not significantly differ in terms of age, gender, baseline NIHSS scores, intraarterial thrombolytic use/dosage, or occlusion site. Time-to-treatment was slightly earlier in Group 1. There was no significant difference in the rates of revascularization (TIMI 2 to 3: 60% versus 65%), mortality (40% versus 38%), or major symptomatic intracranial hemorrhage (SICH; 8.6% versus 8.5%). Group 2 had higher rates of good clinical outcomes (9% versus 35%; P=0.002). This was likely related to a lower prestroke health status in Group 1 patients. In Group 1, successful revascularization was associated with improved outcomes (P=0.015) and lower mortality (24% versus 64%; P=0.033). CONCLUSIONS: Patients with abnormal hemostasis who undergo thrombectomy do not appear to be at a higher risk for SICH but have lower rates of good outcomes. In this patient group, successful revascularization appears to be associated with improved clinical outcomes and lower mortality.
Nogueira et al. (2008) conducted a cohort in Stroke (n=305). Abnormal hemostasis vs. Normal hemostasis was evaluated on Good clinical outcomes (p=0.002). Patients with abnormal hemostasis undergoing endovascular thrombectomy had similar rates of symptomatic intracranial hemorrhage (8.6% vs 8.5%) but lower rates of good clinical outcomes (9% vs 35%; P=0.002).