Journal article
Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial
Annals of neurology, Vol.96(5), pp.887-894
11/2024
DOI: 10.1002/ana.27021
PMID: 39039739
Abstract
Endovascular thrombectomy (EVT) safety and efficacy in patients with large core infarcts receiving oral anticoagulants (OAC) are unknown. In the SELECT2 trial (NCT03876457), 29 of 180 (16%; vitamin K antagonists 15, direct OACs 14) EVT, and 18 of 172 (10%; vitamin K antagonists 3, direct OACs 15) medical management (MM) patients reported OAC use at baseline. EVT was not associated with better clinical outcomes in the OAC group (EVT 6 [4–6] vs MM 5 [4–6], adjusted generalized odds ratio 0.89 [0.53–1.50]), but demonstrated significantly better outcomes in patients without OAC (EVT 4 [3–6] vs MM 5 [4–6], adjusted generalized odds ratio 1.87 [1.45–2.40], p = 0.02). The OAC group had higher comorbidities, including atrial fibrillation (70% vs 17%), congestive heart failure (28% vs 10%), and hypertension (87% vs 72%), suggesting increased frailty. However, the results were consistent after adjustment for these comorbidities, and was similar regardless of the type of OACs used. Whereas any hemorrhage rates were higher in the OAC group receiving EVT (86% in OAC vs 70% in no OAC), no parenchymal hemorrhage or symptomatic intracranial hemorrhage were observed with OAC use in both the EVT and MM arms. Although we did not find evidence that the effect was due to excess hemorrhage or confounded by underlying cardiac disease or older age, OAC use alone should not exclude patients from receiving EVT. Baseline comorbidities and ischemic injury extent should be considered while making individualized treatment decisions. ANN NEUROL 2024
Details
- Title: Subtitle
- Anticoagulation Use and Endovascular Thrombectomy in Patients with Large Core Stroke: A Secondary Analysis of the SELECT2 Trial
- Creators
- Deep K. Pujara - University Hospitals of ClevelandM. Shazam Hussain - Cleveland ClinicMichael G. Abraham - University of Kansas Medical CenterSantiago Ortega-Gutierrez - University of IowaMichael Chen - Rush University Medical CenterScott E. Kasner - University of PennsylvaniaLeonid Churilov - The Royal Melbourne HospitalClark W. Sitton - The University of Texas Health Science Center at HoustonSpiros Blackburn - The University of Texas Health Science Center at HoustonSophia Sundararajan - Case Western Reserve UniversityYin C. Hu - Case Western Reserve UniversityNabeel A. Herial - Thomas Jefferson University HospitalRonald F. Budzik - Riverside Methodist HospitalWilliam J. Hicks - Riverside Methodist HospitalJuan F. Arenillas - Hospital Clínico Universitario de ValladolidJenny P. Tsai - Cleveland ClinicOsman Kozak - Thomas Jefferson University HospitalDennis J. Cordato - Liverpool HospitalNathan W. Manning - Liverpool HospitalRicardo A. Hanel - Baptist Medical Center JacksonvilleAmin N. Aghaebrahim - Baptist Medical Center JacksonvilleTeddy Y. Wu - Christchurch HospitalPere Cardona Portela - Bellvitge University HospitalNatalia Pérez de la Ossa - Hospital Universitari Germans Trias i PujolJoanna D. Schaafsma - Toronto Western HospitalJordi Blasco - Hospital Clínic de BarcelonaNavdeep Sangha - Kaiser PermanenteSteven Warach - The University of Texas at AustinChirag D. Gandhi - Westchester Medical CenterFawaz Al-Mufti - Westchester Medical CenterTimothy J. Kleinig - Royal Adelaide HospitalFaisal Al-Shaibi - Case Western Reserve UniversityKelsey R. Duncan - Case Western Reserve UniversityFaris Shaker - The University of Texas Health Science Center at HoustonHannah Johns - The Royal Melbourne HospitalWei Xiong - University Hospitals of ClevelandMichael DeGeorgia - University Hospitals of ClevelandAmanda Opaskar - Case Western Reserve UniversityJeffery Sunshine - Case Western Reserve UniversityAbhishek Ray - Case Western Reserve UniversityPascal Jabbour - Thomas Jefferson University HospitalNicholas Bambakidis - University Hospitals of ClevelandCathy Sila - Case Western Reserve UniversityThanh N. Nguyen - Boston UniversityJames C. Grotta - Memorial HermannAmeer E. Hassan - Valley Baptist Medical CenterMarc Ribo - Vall d'Hebron Hospital UniversitariMichael D. Hill - University of CalgaryBruce C. Campbell - Florey Institute of Neuroscience and Mental HealthAmrou Sarraj - University Hospitals of ClevelandSELECT2 Investigators
- Resource Type
- Journal article
- Publication Details
- Annals of neurology, Vol.96(5), pp.887-894
- DOI
- 10.1002/ana.27021
- PMID
- 39039739
- NLM abbreviation
- Ann Neurol
- ISSN
- 0364-5134
- eISSN
- 1531-8249
- Language
- English
- Electronic publication date
- 07/22/2024
- Date published
- 11/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984687786202771
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