Blood thinners before blood clot removal in stroke patients improve 90-day death rate, study shows

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A new systematic review and meta-analysis by an international team of researchers found that giving blood-thinning drugs (thrombolysis) before treatment to remove a blood clot from the brain (known as a thrombectomy procedure) in stroke patients improved the 90-day death rate, compared with a simple thrombectomy procedure.

The study, carried out by the University of Bristol and the National University of Singapore in collaboration with researchers from the UK, Germany, Belgium, Sweden and Taiwan, is published in Journal of Neurointerventional Surgery.

Mechanical thrombectomy is effective treatment for patients with an acute stroke caused by a clot (ischemic stroke) from basilar artery occlusion, which occurs with basilar artery occlusion the main artery in the back of the brain, is blocked. The majority of patients with occlusion of large vessels until the results of randomized controlled trials are still recommended to administer blood thinners before removing the thrombus.

However, in patients with basilar artery occlusion who undergo mechanical thrombectomy, it is unclear whether prior treatment with a blood thinner is beneficial. The research team wanted to compare the clinical outcomes of mechanical thrombectomy with and without intravenous thrombolysis in acute basilar artery occlusion through a systematic review and meta-analysis of current literature.

The review included 51 previous studies, and three studies were eligible for inclusion in the study meta-analysis. Three studies compared intravenous thrombolysis with direct mechanical thrombectomy in 1,096 patients with stroke due to basilar artery occlusion.

Of the total number of 1096 patients, 749 were men (68.3%) and 347 were women (31.7%). 362 patients underwent mechanical thrombectomy with bridging intravenous thrombolysis, and 734 patients underwent direct mechanical thrombectomy.

The study showed that patients with acute ischemic stroke due to basilar artery occlusion, compared with direct mechanical thrombectomy, bypass intravenous thrombolysis is associated with a lower mortality rates after 90 days with no increased risk of bleeding. Bridging intravenous thrombolysis is also associated with better functional outcomes, particularly in patients with large atherosclerosis, which is the buildup of fatty material inside the arteries. It is a potentially serious condition that causes the majority of heart attacks and strokes, but often goes undetected.

Keng Siang Lee, a medical student and lead author of the study from Bristol Medical School at the University of Bristol, said: “Our review found that patients with acute ischemic stroke due to basilar artery occlusion had up to four and a half hours of stroke onset, intravenous thrombolysis could improve their 90-day mortality rate.

“If our review is supported in future randomized controlled trials, it may become a standard treatment for stroke patients.”

The research team suggests that future randomized controlled trials are needed to confirm whether bridging intravenous thrombolysis offers advantages over direct mechanical thrombectomy in patients with stroke and basilar artery occlusion.


More stroke patients may benefit from thrombectomy, research suggests


Additional information:
Keng Siang Lee et al., Bypass Thrombolysis Improves 90-Day Survival Compared with Direct Mechanical Thrombectomy Alone in Acute Ischemic Stroke Due to Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of 1096 Patients, Journal of Neurointerventional Surgery (2022). DOI: 10.1136/jnis-2022-019510

Citation: Blood thinners before blood clot removal in stroke patients improve 90-day mortality, study suggests (Oct. 4, 2022) Retrieved Oct. 4, 2022, from https://medicalxpress.com/news/2022-10 -blood-thinning-drugs -clot-patients.html

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