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Updated: Sep 1, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mildly elevated INR is associated with worse outcomes following mechanical thrombectomy for acute ischemic stroke
Huanwen Chen1,2, Ghasan Ahmad3, Marco Colasurdo3
1National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
Background:
Elevated International Normalized Ratio (INR) is a marker of coagulopathy, but its impact on outcomes following mechanical thrombectomy (MT) in patients with stroke is unclear. This study investigates the impact of mild INR elevations on clinical outcomes following MT.
Methods:
In this retrospective cohort study, consecutive patients with stroke treated with MT were identified from 2015 to 2020 at a Comprehensive Stroke Center. Demographic information, past medical history, INR, National Institutes of Health Stroke Scale score, use of tissue plasminogen activator, and last known normal to arteriotomy time were recorded. Outcome measures included modified Thrombolysis in Cerebral Infarction (mTICI) score, modified Rankin Scale (mRS) score at 90 days, and intracerebral hemorrhage (ICH). Patients were divided into two groups: normal INR (0.8-1.1) and mildly elevated INR (1.2-1.7).
Results:
A total of 489 patients were included for analysis, of which 349 had normal INR and 140 had mildly elevated INR. After multivariable adjustments, mildly elevated INR was associated with lower odds of excellent outcomes (mRS 0-1, OR 0.24, p=0.009), lower odds of functional independence (mRS 0-2, OR 0.38, p=0.038), and higher odds of 90-day mortality (OR 3.45, p=0.018). Elevated INR was not associated with a higher likelihood of ICH, and there were no differences in rates of HI1, HI2, PH1, or PH2 hemorrhagic transformations; however, elevated INR was associated with significantly higher odds of 90-day mortality in patients with ICH (OR 6.22, p=0.024). This effect size was larger than in patients without ICH (OR 3.38, p<0.001).
Conclusion:
In patients with stroke treated with MT, mildly elevated INR is associated with worse clinical outcomes after recanalization and may worsen the mortality risk of hemorrhagic transformations.
Insights
Mildly elevated International Normalized Ratio (INR) in stroke patients undergoing mechanical thrombectomy (MT) is linked to poorer outcomes and increased mortality. This finding highlights the importance of INR levels in stroke treatment success.
Area of Science:
- Neurology
- Cardiology
- Hematology
Background:
- Elevated International Normalized Ratio (INR) is a known indicator of coagulopathy.
- The precise impact of mild INR elevations on outcomes after mechanical thrombectomy (MT) for stroke remains unclear.
- This study aims to clarify the association between mild INR elevations and clinical outcomes in stroke patients receiving MT.
Purpose of the Study:
- To investigate the impact of mild International Normalized Ratio (INR) elevations on clinical outcomes in patients undergoing mechanical thrombectomy (MT) for stroke.
- To determine if pre-procedural INR levels influence functional independence, mortality, and risk of hemorrhage after MT.
- To provide evidence-based insights for optimizing stroke treatment protocols.
Main Methods:
- Retrospective cohort study of 489 stroke patients treated with MT between 2015 and 2020.
- Patients were stratified into normal INR (0.8-1.1) and mildly elevated INR (1.2-1.7) groups.
- Outcome measures included modified Rankin Scale (mRS) at 90 days, intracerebral hemorrhage (ICH), and mortality, with multivariable adjustments.
Main Results:
- Mildly elevated INR was associated with significantly lower odds of excellent outcomes (mRS 0-1) and functional independence (mRS 0-2).
- Patients with mildly elevated INR had higher odds of 90-day mortality (OR 3.45).
- While not increasing ICH likelihood, elevated INR worsened mortality risk in patients with ICH (OR 6.22).
Conclusions:
- Mildly elevated INR in stroke patients undergoing MT is associated with adverse clinical outcomes post-recanalization.
- Elevated INR may exacerbate mortality risks, particularly in cases involving hemorrhagic transformations.
- Pre-procedural INR assessment is crucial for predicting outcomes in stroke patients undergoing MT.
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