Abstract
Background:
Heparin is thought to provide an anticoagulant effect preventing catheter related thrombosis duting acute intra-arterial thrombolytics in acute ischemic stroke patients undergoing endovascular procedures.
Objective:
To perform a systematic review to determine the effect of intra-procedural heparin (and intensity) on rates of symptomatic intracerebral hemorrhage (ICH), mortality, and favorable outcome (mRS of 0-2) at 1-3 months.
Methods:
All published trials until 2012 evaluating endovascular treatment were identified from Pubmed using searches with keywords “Catheter based therapy AND Stroke,” “Intra-arterial acute stroke,” “Intra-arterial thrombolysis,”. Studies that reported their treatment time window, baseline median NIH Stroke Scale (NIHSS) score, mean age, and 3-month outcomes were selected. The studies were divided into two groups; endovascular treatment performed with or without intra-procedural heparin. Among those who received heparin, patients were divided into high and low dose heparin. Low dose of heparin was defined as less than 2500 U/hr, and high dose heparin was defined as more than 2500 U/hr.
Results:
A total of 957 (patients in both arms were analyzed) from 33 trials. Intra-procedural heparin was used in 485 of 957 patients (51%); 228 and 257 patients were treated with low dose and high dose heparin, respectively. The rate of symptomatic ICH was not different in patients who received or did not receive intra-procedural heparin (80 of 485 versus 60 of 472, p=0.09). However, trial defined mortality was significantly lower in those who did not receive heparin (107 of 472 versus 141 of 485, p=0.02). There was a significantly higher rate of favorable outcomes at 1 to 3 months in patients who did not receive heparin compared with those who received heparin (305 of 472 versus 264 of 485, p=0.001). . Among patients who received intra-procedural heparin, the rate of symptomatic ICH was significantly higher in those who received high dose heparin as compared to low (dose (55 of 257 versus 25 of 228, p=0.001).
Conclusion:
Intra-procedural use of heparin during endovascular treatment among acute ischemic stroke patients was associated with higher rates of mortality and lower rates of favorable outcomes at 1-3 months.