Safety of Periprocedural Heparin in Acute Ischemic Stroke Endovascular Therapy: The Multi MERCI Trial

Background There are limited data on the safety of periprocedural heparin in acute ischemic stroke endovascular therapy. Methods A post hoc analysis was performed on patients enrolled in the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI) trial to compare baseline characteristics and clinical outcomes between patients who received periprocedural heparin (HEP+ ) with patients who did not receive periprocedural heparin (HEP− ). Data on periprocedural heparin use or nonuse was collected on patients enrolled between February 1, 2006 and July 31, 2006. Results Of 51 patients included in the analysis cohort, 24 (47%) received periprocedural heparin with a median dose of 3000 U. Baseline and procedural characteristics were similar between the 2 groups, although HEP+ patients were more likely to have vertebral or basilar occlusion than HEP− patients (16.7% v 0%; P = .04). There was no significant difference in rates of hemorrhage, procedural complications, or 90-day mortality between the 2 groups. In multivariable analysis, a 90-day good outcome (modified Rankin scale score of 0-2) was associated with age (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.86-0.98; P = .0104), final revascularization success (OR 6.86; 95% CI 1.39-33.81; P = .0179), and periprocedural heparin use (OR 5.89; 95% CI 1.34-25.92; P = .0189). Conclusions In this small subgroup of the Multi MERCI trial, periprocedural heparin use in acute ischemic stroke endovascular therapy was not associated with increased rates of intracerebral hemorrhage or 90-day mortality. The improved 90-day good outcome among patients undergoing mechanical thrombectomy combined with periprocedural heparin warrants further study in a larger cohort.