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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Single-Center Description of Therapeutic Anticoagulation Practices and Outcomes in Large Hemispheric Infarctions
Hannah Breit1, Andrea Sterenstein1, Nandini Abburi1
1Section of Neurocritical Care (HB, AS, SS, SJ, IDS), Department of Neurology, Rush University Medical Center, Chicago, IL; Department of Neurology (NA), University of Washington, Seattle; and Department of Neurology (LK), Temple Health, Philadelphia, PA.
Neurology. Clinical Practice
|December 21, 2022
Summary
Therapeutic anticoagulation (AC) for large hemispheric infarctions (LHIs) showed a low rate of symptomatic hemorrhagic transformation (HT) despite common radiographic findings. Further research is needed on optimal AC timing and safety in LHI patients.
Area of Science:
- Neurology
- Cardiology
- Vascular Medicine
Background:
- Large hemispheric infarctions (LHIs) are associated with high morbidity and mortality.
- Limited data exists on the management and outcomes of therapeutic anticoagulation (AC) in LHI patients.
- Understanding hemorrhagic transformation (HT) rates and clinical impact is crucial for LHI management.
Purpose of the Study:
- To descriptively analyze the types of therapeutic AC used in LHI patients.
- To determine the timing of AC initiation and its association with outcomes.
- To evaluate the rates of radiographic versus symptomatic hemorrhagic transformation (HT) and patient outcomes.
Main Methods:
- Retrospective review of acute ischemic stroke patients admitted to a Neurosciences ICU from 2012-2018.
- Inclusion criteria: LHI (stroke size ≥ 2/3 MCA territory) requiring therapeutic AC.
- Outcomes assessed: HT (radiographic and symptomatic), discharge disposition, and modified Rankin Scale (mRS) scores.
Main Results:
- 105 out of 380 LHI patients received therapeutic AC; mean age 64, 50% female.
- AC initiated at a mean of 17 days post-stroke; common indications included atrial fibrillation (51%).
- Radiographic HT occurred in 65% before AC; only 4% experienced symptomatic deterioration after AC initiation.
Conclusions:
- Radiographic HT is common in LHI patients but does not consistently predict symptomatic decline.
- Therapeutic AC in LHI patients demonstrated a low rate of symptomatic HT.
- Further research is necessary to establish optimal AC timing and safety protocols for LHI management.
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