EFFICACY AND SAFETY OF MINIMAL-DOSE INTRAVENOUS HEPARIN DURING MECHANICAL THROMBECTOMY.

초록

Background and aims: East Asians are known to have a higher risk of bleeding compared to other races, and they often take low doses of antithrombotics. 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. 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 October 2023, 450 patients (68.8 years, 254 men) were included, and 70(15.6%) subjects received intravenous heparin, dose 500-1000 IU bolus, followed by 500 IU/h. There were no differences in baseline characteristics or procedural parameter including procedural time, device, distal migration 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 41.6±10.2 sec). The risk of hemorrhagic conversion on image was significantly higher in heparin group than nonuser group(31.4% vs 21.8%, p=0.04). However, there was no difference in mRS at 90 days and early neurological deficit between the two groups. Conclusions: Even minimal dose of intravenous heparin injection during MT was associated with an increased risk of hemorrhagic conversion without significant change in functional outcome or recanalization status.