Even minimal-dose intravenous heparin injection around mechanical thrombectomy would be related to higherincidence of early hemorrhagic conversion and distal migration without any clinical benefical effect.

초록

Background and Aims: Previous studies indicated the usual dose heparin(5000 IU bolus followed by 500~1250 IU/h) during mechanical thrombectomy(MT) is associated with an increased risk of hemorrhagic conversion without beneficial effect. East Asians are known to have a higher risk of bleeding compared to other races, and they often take lower doses of antithrombotics. However, role of minimal-dose heparin as an adjuvant treatment during MT in East Asians remains unclear. Methods: We enrolled the patients who underwent MT from the Inha University Hospital Stroke Prospective Registry and compared clinical findings between patients who received heparin during MT and those who did not. Results: From January 2016 to March 2024, 460 patients (68.8 years, 270 men) were included, and 70(15.2%) subjects received intravenous heparin, dose 500-1000 IU bolus, followed by 500 IU per hour. There were no differences in baseline characteristics or procedural parameter including procedural time, device, and TICI grade between two groups. However, intravenous thrombolysis was performed more frequently in the non-user group than in the heparin group, and the apTT value after the procedure was higher in the heparin group than in the other groups(75.9±12.5 vs 40.8±10.1 sec). The risk of hemorrhagic conversion on image was significantly higher in heparin group than non user group(31.4% vs 21.3%, p=0.04). This trend also seemed to be seen in patients who did not undergo intravenous thrombolysis group. This Early distal migration of embolus, defined as difference location of embolus between initial CT angiography and initial conventional angiographym was observed more frequently in heparin group,