P-026 Mild coagulopathy is associated with worse outcomes following stroke thrombectomy. (23rd July 2022)

• Record Type: Journal Article
• Authors: Chen, H; Ahmad, G; Colasurdo, M; Yarbrough, K; Schrier, C; Phipps, M; Cronin, C; Mehndiratta, P; Cole, J; Wozniak, M; Miller, T; Gandhi, D; Jindal, G; Chaturvedi, S
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A65
• Page End: A65
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.98
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background and Purpose: Elevated International Normalized Ratio (INR) is a marker of coagulopathy, however, its impact on outcomes following mechanical thrombectomy (MT) in stroke patients is unclear. This study investigates the impact of mild INR elevations on clinical outcomes following MT. Methods: Consecutive patients who underwent stroke thrombectomy were identified from January 2015 to December 2020 at a Comprehensive Stroke Center. Demographic information, past medical history, INR, NIHSS, tPA use, and last-known-normal to arteriotomy time were recorded. Outcome measures including modified thrombolysis in cerebral infarction (mTICI) score, modified Rankin Scale (mRS) at 90 days, and intracerebral hemorrhage (ICH). Patients were divided into two groups, normal INR (0.8–1.1) and mildly elevated INR (1.2–1.7), for comparisons. Results: 508 patients were identified. 18 patients with an INR greater than 1.7 and 1 patient without INR data were excluded. Of the remaining 489 patients, 349 had normal INR, and 140 had mildly elevated INR. After multivariable adjustments, mildly elevated INR was associated with lower odds of excellent outcomes (mRS 0–1, OR 0.24, p=0.009), lower odds of functional independence (mRS 0–2, OR 0.38, p=0.038), and higher odds of 90-day mortality (OR 3.45, p=0.018). Elevated INR was not associated with higher likelihood of ICH; however, it was associated with significantly higher odds of 90-day mortality in patients with ICH (OR 6.22, p=0.024). This effect size was larger than in patients without ICH (OR 3.38, p<0.001). Finally, elevated INR did not significantly impact outcomes without reperfusion (mTICI 0 or 1, p=0.46), whereas it was associated with worse outcomes after mTICI 2c or 3 reperfusion (p=0.003). Conclusions: In stroke thrombectomy patients, mildly elevated INR is associated with worse clinical outcomes after recanalization and may worsen the mortality risk of hemorrhagic transformations. Disclosures: H. Chen: None. G. Ahmad: None. M. Colasurdo: None. K. Yarbrough: None. C. Schrier: None. M. Phipps: None. C. Cronin: None. P. Mehndiratta: None. J. Cole: None. M. Wozniak: None. T. Miller: None. D. Gandhi: None. G. Jindal: None. S. Chaturvedi: None.