Study Evaluates Mechanical Thrombectomy in Orally Anticoagulated Stroke Patients


August 29, 2018—Mechanical thrombectomy is feasible in orally anticoagulated patients with acute ischemic stroke, concluded Gustavo Zapata-Wainberg, MD, et al for the Madrid Stroke Network in a study published in the Journal of NeuroInterventional Surgery (JNIS; 2018;10:834–838). The investigators found that the outcomes and safety profile in the treatment of these patients are similar to those of patients with no previous anticoagulation therapy.

As summarized in JNIS, the retrospective multicenter study sought to investigate the efficacy and safety of mechanical thrombectomy in patients with acute ischemic stroke according to the oral anticoagulation medication taken at the time of stroke onset. Data were prospectively collected from consecutively treated patients in the Madrid Stroke Network registry.

Of 502 patients in the study, 389 (77.5%) were not anticoagulated, 104 (20.7%) were taking vitamin K antagonists, and nine (1.8%) were taking direct oral anticoagulants. Intravenous thrombolysis had been performed in 59.8% of nonanticoagulated patients and 15% of anticoagulated patients. The frequency of intracranial hemorrhage and the modified Rankin Scale (mRS) score at 3 months were compared according to anticoagulation status.

The investigators found that rates of intracranial hemorrhage after treatment were similar between nonanticoagulated and anticoagulated patients, as were rates of recanalization. After 3 months of follow-up, the mRS score was ≤ 2 in 56.3% of nonanticoagulated and 55.7% of anticoagulated patients (P = NS) and mortality rates were similar (13.1% vs 12.4%). Among anticoagulated patients, no differences were found for intracranial bleeding, mRS score, or mortality rates between patients taking vitamin K antagonists and those taking direct oral anticoagulants, reported the investigators in JNIS.


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