title: Role of heparin during endovascular therapy for acute ischemic stroke.
abstract: OBJECTIVE
  Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS).
  
  
  METHODS
  We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale).
  
  
  RESULTS
  Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days.
  
  
  CONCLUSIONS
  The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation.
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, FL, United States.
authors.forename: Naureen
authors.initials: N
authors.lastname: Farook
authors.affiliation: Emory University Hospital/Grady Memorial Hospital Marcus Stroke and Neuroscience Center, Atlanta, GA, United States.
authors.forename: Diogo
authors.initials: D
authors.lastname: Haussen
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Neurological Surgery, Miami, FL, United States.
authors.forename: Samir
authors.initials: S
authors.lastname: Sur
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Neurological Surgery, Miami, FL, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Snelling
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, FL, United States.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Gersey
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Neurological Surgery, Miami, FL, United States.
authors.forename: Dileep
authors.initials: D
authors.lastname: Yavagal
authors.affiliation: University of Miami Miller School of Medicine/Jackson Memorial Hospital, Department of Neurological Surgery, Miami, FL, United States. Electronic address: ericpete@med.miami.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Acute ischemic stroke; Endovascular therapy; Hemorrhage; Heparin; Intraarterial therapy