Blood thinning drugs before removing a clot in stroke patients improves mortality rates at 90 days, study finds

Medical Xpress / University of Bristol / Journal of NeuroInterventional Surgery ^ | Oct. 4, 2022 | Keng Siang Lee et al

[ConservativeMind]

A new systematic review and meta-analysis by an international group of researchers has found giving a blood thinning drug (thrombolysis) before treatment to remove a clot from the brain—known as thrombectomy procedure—to stroke patients, improved mortality rates at 90 days, compared with just thrombectomy procedure alone.

Mechanical thrombectomy is an effective treatment for patients with an acute stroke caused by a clot (ischemic stroke) from basilar artery occlusion, which occurs when the basilar artery, the main artery at the back portion of the brain, is blocked. Administering a bridging blood thinning drug before removing a clot is still recommended for most patients with large-vessel occlusion pending results of randomized controlled trials.

However, in patients with basilar artery occlusion who undergo mechanical thrombectomy, it is not clear whether or not prior treatment with a bridging blood thinning drug is beneficial. The research team wanted to compare the clinical outcomes of mechanical thrombectomy, with and without bridging intravenous thrombolysis, in acute basilar artery occlusion through a systematic review and meta-analysis of the current literature.

The study found that in patients with acute ischemic stroke due to basilar artery occlusion, compared with direct mechanical thrombectomy, bridging intravenous thrombolysis is associated with lower mortality rates at 90 days without an increased risk of bleeding. Bridging intravenous thrombolysis is also associated with better functional outcomes particularly in patients with large atherosclerosis, which is the build-up of fatty material inside arteries. It's a potentially serious condition that causes most heart attacks and strokes but often goes unnoticed.

Keng Siang Lee said, "Our review has found in patients with acute ischemic stroke due to basilar artery occlusion, who present up to four and a half hours from the start of their stroke, bridging intravenous thrombolysis could improve their 90 day death rate.

[ConservativeMind]

From the study, it appears the relative risk for everyone is definitely in favor of using blood thinners early (0.70). Also, it appears those with large artery atherosclerosis did 2.52X better with it.

“Specifically patients with large artery atherosclerosis (LAA) benefited from bridging intravenous thrombolysis (IVT) (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with Mechanical thrombectomy alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008).”

[ConservativeMind]

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[moovova]

Jabbees will be glad to hear this.