Seyed Behnam Jazayeri , Sherief Ghozy , Ram Saha , Aryan Gajjar , Mohamed Elfil , David F. Kallmes
{"title":"重新评估肝素在急性缺血性脑卒中机械性血栓切除术中的作用:风险增加却无功能性益处","authors":"Seyed Behnam Jazayeri , Sherief Ghozy , Ram Saha , Aryan Gajjar , Mohamed Elfil , David F. Kallmes","doi":"10.1016/j.clineuro.2024.108560","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Heparin may be administered during mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusions (AIS-LVO), with the aim of enhancing reperfusion and improving patient outcomes. The uncertain balance between risks and benefits of administering heparin during MT prompted us to perform this systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted in PubMed, Embase, and Scopus to find studies that report the safety or efficacy of administering heparin during MT for AIS-LVO. Meta-analysis was performed using the random effects model. In case of significant heterogeneity a subgroup analysis was performed.</div></div><div><h3>Results</h3><div>From 2398 screened records, we included 15 studies. Rate of favorable functional outcome (90 day modified Rankin Scale 0–2 (mRS 0–2)) was lower among patients who received heparin (OR, 0.88 [95 %CI 0.79–0.98]; p=.023). Risk of distal embolization was higher in patients who received heparin (OR, 1.25 [95 %CI 1.01–1.55]; p=.04). The subgroup analysis showed that patients who received intravenous thrombolysis (IVT) had higher risk of Symptomatic intracranial hemorrhage (sICH) (OR, 2.94 [95 %CI 1.30–6.63]; p=.009) and lower rate of mRS 0–2 (OR, 0.66 [95 %CI 0.50–0.87]; p=.004). Heparin use didn’t affect successful reperfusion rate (Thrombolysis in cerebral infarction ≥2B), mortality or any ICH risk.</div></div><div><h3>Conclusion</h3><div>Overall, our analysis indicates that administering heparin during MT for AIS-LVO correlates with worse clinical outcomes and increased distal embolization rates. Moreover, it is linked to a higher risk of sICH in patients who receive IVT. Consequently, the routine utilization of heparin during MT should be reconsidered.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108560"},"PeriodicalIF":1.8000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Reevaluating the role of heparin during mechanical thrombectomy for acute ischemic stroke: Increased risks without functional benefit\",\"authors\":\"Seyed Behnam Jazayeri , Sherief Ghozy , Ram Saha , Aryan Gajjar , Mohamed Elfil , David F. Kallmes\",\"doi\":\"10.1016/j.clineuro.2024.108560\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Heparin may be administered during mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusions (AIS-LVO), with the aim of enhancing reperfusion and improving patient outcomes. The uncertain balance between risks and benefits of administering heparin during MT prompted us to perform this systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted in PubMed, Embase, and Scopus to find studies that report the safety or efficacy of administering heparin during MT for AIS-LVO. Meta-analysis was performed using the random effects model. In case of significant heterogeneity a subgroup analysis was performed.</div></div><div><h3>Results</h3><div>From 2398 screened records, we included 15 studies. Rate of favorable functional outcome (90 day modified Rankin Scale 0–2 (mRS 0–2)) was lower among patients who received heparin (OR, 0.88 [95 %CI 0.79–0.98]; p=.023). Risk of distal embolization was higher in patients who received heparin (OR, 1.25 [95 %CI 1.01–1.55]; p=.04). The subgroup analysis showed that patients who received intravenous thrombolysis (IVT) had higher risk of Symptomatic intracranial hemorrhage (sICH) (OR, 2.94 [95 %CI 1.30–6.63]; p=.009) and lower rate of mRS 0–2 (OR, 0.66 [95 %CI 0.50–0.87]; p=.004). Heparin use didn’t affect successful reperfusion rate (Thrombolysis in cerebral infarction ≥2B), mortality or any ICH risk.</div></div><div><h3>Conclusion</h3><div>Overall, our analysis indicates that administering heparin during MT for AIS-LVO correlates with worse clinical outcomes and increased distal embolization rates. Moreover, it is linked to a higher risk of sICH in patients who receive IVT. Consequently, the routine utilization of heparin during MT should be reconsidered.</div></div>\",\"PeriodicalId\":10385,\"journal\":{\"name\":\"Clinical Neurology and Neurosurgery\",\"volume\":\"246 \",\"pages\":\"Article 108560\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Neurology and Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0303846724004475\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0303846724004475","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Reevaluating the role of heparin during mechanical thrombectomy for acute ischemic stroke: Increased risks without functional benefit
Background
Heparin may be administered during mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusions (AIS-LVO), with the aim of enhancing reperfusion and improving patient outcomes. The uncertain balance between risks and benefits of administering heparin during MT prompted us to perform this systematic review and meta-analysis.
Methods
A comprehensive search was conducted in PubMed, Embase, and Scopus to find studies that report the safety or efficacy of administering heparin during MT for AIS-LVO. Meta-analysis was performed using the random effects model. In case of significant heterogeneity a subgroup analysis was performed.
Results
From 2398 screened records, we included 15 studies. Rate of favorable functional outcome (90 day modified Rankin Scale 0–2 (mRS 0–2)) was lower among patients who received heparin (OR, 0.88 [95 %CI 0.79–0.98]; p=.023). Risk of distal embolization was higher in patients who received heparin (OR, 1.25 [95 %CI 1.01–1.55]; p=.04). The subgroup analysis showed that patients who received intravenous thrombolysis (IVT) had higher risk of Symptomatic intracranial hemorrhage (sICH) (OR, 2.94 [95 %CI 1.30–6.63]; p=.009) and lower rate of mRS 0–2 (OR, 0.66 [95 %CI 0.50–0.87]; p=.004). Heparin use didn’t affect successful reperfusion rate (Thrombolysis in cerebral infarction ≥2B), mortality or any ICH risk.
Conclusion
Overall, our analysis indicates that administering heparin during MT for AIS-LVO correlates with worse clinical outcomes and increased distal embolization rates. Moreover, it is linked to a higher risk of sICH in patients who receive IVT. Consequently, the routine utilization of heparin during MT should be reconsidered.
期刊介绍:
Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.