Abstract 266: Endovascular Thrombectomy in Patients on Long‐Term Anticoagulation

Introduction Endovascular thrombectomy (EVT) has become a popular treatment of acute ischemic stroke (AIS) due to its favorable clinical endpoints in comparison to intravenous thrombolysis (IvT). Many patients who present with conditions necessitating thrombectomy are on long‐term oral anticoagulation therapy (AC) due to comorbidities and/or prophylactic prevention. ACs are a risk factor for intracerebral hemorrhage (ICH) in AIS patients treated with IvT, but evidence on the risk for patients treated with EVT is scarce. ACs may also alter clot composition to allow for easier recanalization and improved clinical outcomes following EVT, but clinical evidence is uncertain. We sought to compare the risk of ICH and clinical outcomes of patients on anticoagulant therapy treated with EVT vs. non‐anticoagulated (non‐AC) patients treated with EVT for AIS. Methods The National Inpatient Sample, an approximation of a 20% stratified sample of discharges from US community hospitals, was queried for all patients seen from 2016 to 2020 that underwent EVT for AIS. That sample was divided into patients on preexisting anticoagulation therapy and those that were not. Patients on long‐term AC therapy were identified using appropriate ICD10 codes and compared to those who were not on long‐term AC therapy. Results Of the 2,946,195 patients presenting with AIS, 287,405 (9.8%) were on long‐term AC therapy. Patients on long‐term AC therapy were less likely to have aphasia, hemiplegia, brain herniation, coma, and mechanical ventilation (all p's <0.001) when compared to those who were not on long‐term AC therapy. Despite AIS patients on long‐term AC therapy having less rates of serious features on presentation than nonAC patients, AIS patients on AC that underwent EVT were more likely to experience ICH (14.1% vs 12%; OR 1.206, 95% CI 1.058‐1.375, p=0.006) and less likely to be discharged home (35% vs 39.4%; OR 0.831, 95% CI 0.758‐0.91, p<0.001) as compared to their propensity score matched non‐AC counterparts undergoing EVT. Patients undergoing EVT experienced similar inpatient mortality (8.8% vs 9.6%; OR 0.913, 95% CI 0.784‐1.064, p = 0.260) and length of stay (LOS) (54.7% vs 55.7%; OR 0.958, 95% CI 0.877‐1.047, p=0.355) irrespective of AC therapy. Conclusion Long‐term AC may provide a protective effect in the setting of AIS. Although EVT is associated with increased risk of ICH in patients on long‐term AC, in‐hospital mortality and length of stay are similar to those not on long‐term AC. These findings support EVT as an option for treatment in AC patients, but research identifying optimal patient selection for EVT in the setting of long‐term AC is necessary.