Abstract TP200: Anticoagulation Use and Endovascular Thrombectomy in Patients With Large Core Stroke - A Secondary Analysis of SELECT2 Trial

Abstract

Introduction: Anticoagulation (AC) use is common in patients presenting with acute ischemic stroke and is known to pose challenges to acute reperfusion therapy. However, evidence about association of AC use prior to stroke with endovascular thrombectomy outcomes and post-procedure hemorrhages, especially in those with large strokes is limited. Methods: From SELECT2, patients were stratified based on AC medication use and prior to stroke. Functional outcomes at 90day follow-up and hemorrhagic transformation on follow-up imaging were compared between patients with and without AC in adjusted regression models. Results: Of 352 patients, 29/180 (16%, VKA - 15, DOACs 14) EVT patients and 18/172 (10%, VKA - 3, DOACs 15) MM patients were receiving anticoagulants at baseline. AC patients were older (72 (62-79) y vs 66 (58-75) y), with higher cardiac morbidity (Congestive Heart Failure: 28% vs 10%, Atrial Fibrillation: 70% vs 17%), but had similar NIHSS [20 (16-24) vs 18 (15-23)], time to randomization [511 (350-909) vs 586 (326-920) minutes], CT ASPECTS [4 (3-5) vs 4 (3-5)] and ischemic core estimates [91 (71 -110) vs 103 (71-139) ml, AC vs nonAC respectively]. Within AC patients, EVT did not improve outcomes (Shift: 6 (4-6) vs 5 (4-6), aGenOR: 0.89 (0.53-1.50), mRS 0-3: 11% vs 14%, aRR: 1.27 (0.40-4.05), mRS 5-6: 69% vs 67%, aRR: 1.05 (0.73-1.50)]. Furthermore, EVT patients on AC reported numerically higher rates of any intracerebral hemorrhage [85.7% vs 70.2%, aRR: 1.18, 95% CI: 0.98-1.43], but no sICH or parenchymal hemorrhage and demonstrated worse outcome [median mRS: 6 (4-6) vs 4 (3-6), aGenOR: 0.49(0.32-0.74)], mRS 0-3: 14% vs 43%, aRR: 0.36 (0.15-0.86)], and mRS 5-6: 69% vs 43%, aRR: at 90 day follow-up and numerically lower functional independence (mRS 0-2) [3.4% vs 23.3%, aRR: 0.18(0.03-1.21)], AC vs nonAC respectively. Consistent results were observed in patients achieving successful reperfusion. Conclusion: Almost 1/7 th of patients presenting with large stroke in SELECT2 trial demonstrated AC use at baseline, with higher cardiac morbidity. These patients were more likely to have hemorrhagic outcomes and worse clinical outcomes after EVT and successful reperfusion. Clinicaltrials.gov registration: NCT03876457