Impact of thrombocytopenia on hemorrhagic complications after endovascular therapy for acute large vessel occlusion: Sub-analysis of RESCUE-Japan registry 2.

Autor: Fujiwara S; Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan., Sakai N; Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan., Imamura H; Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan., Ohara N; Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan., Tanaka K; Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Japan., Yamagami H; Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan., Matsumoto Y; Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan., Takeuchi M; Department of Neurosurgery, Seishou Hospital, Odawara, Japan., Uchida K; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan., Yoshimura S; Department of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan., Morimoto T; Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan. Electronic address: morimoto@kuhp.kyoto-u.ac.jp.
Jazyk: angličtina
Zdroj: Journal of the neurological sciences [J Neurol Sci] 2023 Jun 15; Vol. 449, pp. 120659. Date of Electronic Publication: 2023 Apr 13.
DOI: 10.1016/j.jns.2023.120659
Abstrakt: Background: Endovascular treatment (EVT) for patients with large vessel occlusion (LVO) and concurrent thrombocytopenia raises concerns about hemorrhagic complications. We examined the association between thrombocytopenia and clinical outcomes after EVT.
Methods: This is a sub-analysis of the RESCUE-Japan Registry 2, a nationwide registry that enrolled 2420 consecutive acute LVO patients. We evaluated the clinical outcomes in patients who underwent EVT according to their platelet count on admission (Moderate/Severe, < 100 × 10 9 /L; Mild, 100 to ≤150 × 10 9 /L; Normal, ≥ 150 × 10 9 /L). The outcomes included any and symptomatic intracranial hemorrhage (ICH) after EVT, and modified Rankin Scale (mRS) at 90 days.
Results: Of 1268 patients who underwent EVT, the Moderate/Severe and Mild groups consisted of 41 (3.2%), and 193 (15.2%) patients. Any ICH occurred in 37%, 35%, and 24% of Moderate/Severe, Mild, and Normal group patients, respectively, and the adjusted ORs (95% CIs) were 1.50 (0.71-3.18) for Moderate/Severe and 1.87 (1.28-2.73) for Mild, compared to the Normal group (p for trend = 0.004). Symptomatic ICH increased with the severity of thrombocytopenia (9.8% vs 3.6% vs 2.1%), and adjusted ORs were 4.43 (1.16-17.0) in Moderate/Severe and 1.85 (0.71-4.86) in Mild (p for trend = 0.10). Mortality was significantly associated with the severity of thrombocytopenia (p for trend = 0.005), and adjusted ORs were 3.26 (1.29-8.26) in the Moderate/Severe and 2.76 (1.58-4.84) in the Mild groups.
Conclusions: Thrombocytopenia in LVO patients was not rare and associated with the incidence and manifestation of ICH after EVT.
Competing Interests: Declaration of Competing Interest Dr. Fujiwara: None. Dr. Sakai reports research grants from Biomedical Solutions, NeuroVasc, and Terumo; lecturer's fees from Asahi-Intec, Biomedical Solutions, Medtronic, and Terumo; membership of the advisory boards for Johnson&Johnson, Medtronic, and Terumo not related to this manuscript. Dr. Imamura reports lecturer's fees from Medtronic, Stryker, Johnson & Johnson, Terumo, and Asahi-Intec J-sales. Dr. Tanaka reports lecturer's fees from Johnson & Johnson and Stryker. Dr. Ohara: none. Dr. Yamagami reports a research grant from Bristol-Myers Squibb, lecturer's fees from Bayer, Daiichi-Sankyo, Stryker, Medtronic, Johnson &Johnson, Terumo, and Medicos Hirata; and membership of the advisory board for Daiichi-Sankyo. Dr. Matsumoto reports lecturer's fees from GE Healthcare, Medico's Hirata, Medtronic, Stryker, Century medical, Takeda Pharmaceutical Limited, Otsuka Pharmaceutical Limited, Kaneka Medix and Fuji Systems; reports leadership position/advisory role for GE Health care, Fuji systems, Medicos Hirata, Stryker Corporation; and reports patents and royalties from Sumitomo Bakelite. Dr. Takeuchi reports lecturer's fees from Daiichi Sankyo and Stryker. Dr. Uchida reports lecturer's fees from Daiichi Sankyo. Dr. Yoshimura reports research grants from Medtronic, Medicos Hirata, Termo, Bristol-Myers Squibb, and Otsuka; lecturers' fees from Daiichi Sankyo, Pfizer, Boehringer-Ingelheim, Otsuka, Bayer, Pfizer, Bristol-Myers Squibb, Stryker, Medtronic, and Mitsubishi Tanabe. Dr. Morimoto reports lecturer's fees from AstraZeneca, Bristol-Myers Squibb, Daiichi Sankyo, Japan Lifeline, Kowa, Toray and Tsumura; manuscript fees from Bristol-Myers Squibb and Kowa; advisory board for Novartis and Teijin.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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