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Following endovascular treatment ofischemic stroke , many patients fail to recover despite rapid and successful angiographic reperfusion due to occlusion of large intracranial vessels in the anterior circulation .
Perioperative antithrombotic drugs enhance angiography and microvascular recanalization and are frequently used to reduce thrombotic complications .
However, for aspirin and heparin, it is unclear whether the potential benefits of perioperative use outweigh the possible increased risk of symptomatic intracranial hemorrhage .
.
Because aspirin increased the risk of developing intracranial hemorrhage in previous trials, guidelines recommend against using aspirin early after intravenous thrombolysis, but there is no evidence of favorable efficacy
.
However, in this trial of patients with ischemic stroke who received intravenous thrombolysis before endovascular therapy, the intervention group had a low 4.
3% risk of symptomatic intracranial hemorrhage
guide
In the current study, the Netherlands Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke (MR CLEAN-MED), investigators sought to evaluate the initiation of endovascular therapy with intravenous aspirin, unfractionated heparin, both, or neither.
Safety and efficacy in patients with ischemic stroke due to anterior circulation large vessel occlusion
In the current study, the Netherlands Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke (MR CLEAN-MED), investigators sought to evaluate the initiation of endovascular therapy with intravenous aspirin, unfractionated heparin, both, or neither.
Safety and efficacy in patients with ischemic stroke due to anterior circulation large vessel occlusion
We conducted an open-label, multicenter, randomized controlled trial with a 2 × 3 factorial design at 15 centers in the Netherlands
.
We recruited adult patients (ie, ≥18 years of age) with ischemic stroke due to anterior circulation large vessel occlusion who could initiate endovascular therapy within 6 hours of symptom onset
An open-label, multicenter, randomized controlled trial investigators enrolled adult patients (ie, ≥18 years of age) with ischemic stroke due to anterior circulation large vessel occlusion who could initiate vascular initiation within 6 hours of symptom onset internal treatment
- Between January 22, 2018, and January 27, 2021, 663 patients were randomized; 628 (95%) of whom provided deferred consent or died before consent could be requested and were included in modified intention-to-treat crowd
.
On February 4, 2021, following unblinding and analysis of the data, the trial steering committee permanently halted patient recruitment and the trial was halted due to safety concerns
Both perioperative intravenous aspirin and unfractionated heparin during endovascular therapy increased the risk of symptomatic intracranial hemorrhage, but there was no evidence of a beneficial effect on functional outcomes
van der Steen W, van de Graaf RA, Chalos V, et al.
Safety and efficacy of aspirin, unfractionated heparin, both, or neither during endovascular stroke treatment (MR CLEAN-MED): an open-label, multicentre, randomised controlled trial .
Lancet.
2022;399(10329):1059-1069.
doi:10.
1016/S0140-6736(22)00014-9 Leave a message here
