Post-endovascular thrombectomy d-dimer and outcomes in anterior circulation large-vessel occlusion stroke: a post hoc analysis of MARVEL trial

Risk stratification after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) remains challenging. We assessed whether post-EVT d -dimer is associated with outcomes. This post hoc analysis included 881 MARVEL trial (82 centers in China) patients and plasma d -dimer measurement within 48 h after EVT. Post-EVT d -dimer was analyzed as tertiles (T1 < 0.8 mg/L; T2 0.8–2.6 mg/L; T3 > 2.6 mg/L), as a continuous variable, and as a log2-transformed continuous variable. The primary outcome was functional independence (90-day modified Rankin Scale [mRS] 0–2). Secondary outcomes were 90-day mRS shift, symptomatic intracranial hemorrhage (sICH) within 48 h, and 90-day mortality. Associations were examined using adjusted logistic and ordinal logistic models. Higher post-EVT d -dimer was independently associated with lower odds of mRS 0–2. In Model 1, each doubling of post-EVT d -dimer was associated with lower odds of mRS 0–2 (adjusted odds ratio [aOR], 0.75; 95% CI 0.68–0.82; p < 0.001). Compared with T1, odds of mRS 0–2 were lower in T2 (aOR, 0.49; 95% CI 0.34–0.71; p < 0.001) and T3 (aOR, 0.33; 95% CI 0.22–0.49; p < 0.001). Higher d -dimer was associated with a less favorable 90-day mRS distribution (adjusted common odds ratio, 0.74; 95% CI 0.69–0.79; p < 0.001), higher sICH risk (aOR, 1.47; 95% CI 1.29–1.67; p < 0.001), and higher mortality (aOR, 1.41; 95% CI 1.27–1.56; p < 0.001). Baseline National Institutes of Health Stroke Scale (NIHSS) modified the association with mRS 0–2 ( p for interaction = 0.006), with stronger associations when NIHSS > 19. Post-EVT d -dimer within 48 h was associated with worse functional outcomes, higher sICH risk, and increased mortality after EVT for LVO stroke. Trial registration Chinese Clinical Trial Registry; Identifier: ChiCTR2100051729. Registered on October 1, 2021.