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Association Between Prior Anticoagulation and Thrombus Composition in Mechanical Thrombectomy Patients with Atrial

Chendong Wang1, Yu Hang1, Yuezhou Cao1

  • 1Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|February 14, 2022
PubMed

Insights

Prior anticoagulation in atrial fibrillation patients with acute ischemic stroke alters thrombus composition, showing increased fibrin and platelets but fewer red blood cells. This suggests potential differences in stroke treatment response.

Area of Science:

  • Neurology
  • Cardiology
  • Hematology

Background:

  • Anticoagulation (AC) is crucial for preventing ischemic stroke in atrial fibrillation (AF) patients.
  • Understanding thrombus composition is key to optimizing stroke treatment strategies.

Purpose of the Study:

  • To investigate the association between prior anticoagulation (AC) and thrombus composition in AF patients experiencing acute ischemic stroke (AIS).
  • To evaluate the impact of prior AC on clinical outcomes following mechanical thrombectomy (MT) in AIS patients with AF.

Main Methods:

  • Analysis of 133 consecutive AIS patients with AF undergoing MT.
  • Quantitative analysis of thrombus composition (RBC, WBC, fibrin, platelets) using H&E and MSB staining.
  • Comparison of procedural and clinical outcomes between patients with and without prior AC.

Main Results:

  • Thrombi in the AC group (n=39) showed significantly higher fibrin (36% vs 20%) and platelet (36% vs 24%) content, and lower RBC content (25% vs 54%) compared to the non-AC (NAC) group (n=94).
  • No statistically significant differences were observed in successful recanalization rates (mTICI 2b-3: 97% vs 86%) or functional independence at 90 days (mRS 0-2: 44% vs 33%).

Conclusions:

  • Prior anticoagulation in AF patients with AIS is associated with thrombi characterized by increased fibrin and platelets, and decreased red blood cells.
  • A trend towards higher successful reperfusion rates in prior AC patients was noted but did not reach statistical significance.
Abstract

Keywords:
AnticoagulationAtrial fibrillationCompositionStrokeThrombus

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