BACKGROUND AND PURPOSE Data on safety and efficacy of periprocedural use of heparin are limited during treatment of acute ischemic stroke patients with anterior circulation tandem occlusion. This study aimed to investigate the impact of heparin use during endovascular therapy of anterior circulation tandem occlusions on the functional and safety outcomes. METHODS A retrospective analysis of the multicenter observational TITAN registry was performed. Patients with anterior circulation tandem occlusion and treated with endovascular therapy (EVT) were included, with or without extracranial carotid intervention. We divided patients into two groups based on periprocedural heparin use (heparin vs. non-heparin). The dose of intravenous unfractionated heparin ranged from 1500 to 2500 I.U. Primary study endpoint was 90-day Modified Rankin Scale (mRS). Secondary study endpoint included angiographic and safety endpoints such as hemorrhagic complications. A propensity-score-matched analysis was performed. RESULTS Among 369 patients, heparin was used in 68 patients (18.4%). In the propensity-score-matched cohort, favorable outcome (mRS 0-2) occurred in 51.3% in heparin group and 58.0% in non-heparin group (matched OR, 0.76; 95% CI, 0.32-1.78; P = 0.52). Similar result was found in propensity-score-adjusted cohort (adjusted OR, 0.72; 95%CI, 0.39-1.32; P = 0.28). Likewise, there was no difference in the rate of successful reperfusion (mTICI 2b-3) (propensity-score-adjusted OR, 1.03; 95%CI, 0.50-2.09; P = 0.93) neither in safety endpoints between the two groups. CONCLUSIONS Periprocedural heparin use during EVT of anterior circulation tandem occlusions was not associated with better functional, angiographic or safety outcomes. These findings are applicable for low doses of heparin, and further studies are warranted.

中文翻译：

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急性缺血性卒中患者的串联病变血管内治疗过程中的围术期肝素：TITAN注册中心的倾向评分分析。

背景与目的在急性缺血性中风前循环串联闭塞治疗中，围手术期使用肝素的安全性和有效性数据有限。这项研究旨在调查前循环串联闭塞的腔内治疗期间使用肝素对功能和安全性结果的影响。方法对多中心观察性TITAN注册中心进行回顾性分析。包括前循环串联闭塞并接受血管内治疗（EVT）的患者，有或没有颅外颈动脉介入治疗。我们根据围手术期肝素使用情况将患者分为两组（肝素与非肝素）。静脉内普通肝素的剂量范围为1500至2500 IU。主要研究终点为90天改良兰金量表（mRS）。次要研究终点包括血管造影和安全终点，例如出血并发症。进行了倾向得分匹配的分析。结果在369例患者中，有68例患者使用了肝素（18.4％）。在倾向评分匹配的队列中，肝素组有51.3％的患者有良好的预后（mRS 0-2），非肝素组有58.0％的患者（匹配OR，0.76； 95％CI，0.32-1.78； P = 0.52） 。在倾向得分调整后的队列中也发现了类似的结果（调整后的OR为0.72； 95％CI为0.39-1.32； P = 0.28）。同样，两组的安全终点均无成功再灌注率（mTICI 2b-3）（倾向得分调整后的OR，1.03； 95％CI，0.50-2.09； P = 0.93）。结论：前循环串联闭塞EVT期间围手术期使用肝素与更好的功能，血管造影或安全性结果。这些发现适用于小剂量肝素，因此有必要进一步研究。