Abstract 454: Use of Intravenous Heparin For Patients With Acute Ischemic Stroke Due to Subocclusive Intracranial Thrombus

Background Sub‐occlusive thrombus in an intracranial artery is a rare cause of acute ischemic stroke, and there is limited data regards to its acute management. Historically, those patients had been treated with heparin drip and then transitioned to oral anticoagulation. We aim to analyze the effect of intravenous heparin in patients with acute ischemic stroke due to sub‐occlusive intracranial thrombus. Method We retrospectively reviewed patients with a diagnosis of acute ischemic stroke from 2019‐2023. We selected patients who met the inclusion criteria: 1) diagnosis of sub‐occlusive thrombus by neuroradiologist using Computed Tomography angiography (CTA), 2) acute treatment with heparin drip. We identified 18 patients with the diagnosis of sub‐occlusive thrombus. Good outcome at 90 days was defined as modified Rankin Score of ≤2, resolution of sub‐occlusive thrombus was evaluated with CTA at 6 months. Results Out of the 18 patients, 50% were females. The mean age was 62.7 years. The median duration of the heparin drip was 42.5 hours. The median NIHSS score on admission was 6. Of the 14 patients with a 90‐day mRS, 7 (50%) had a good outcome (mRS ≤2). In our study, 4 patients (22.2%) had recurrent ischemic stroke, one patient had a systemic hemorrhage, and two patients had an intracranial hemorrhage 10 days after the initial hospitalization. Thirteen patients (72.2%) were transitioned to apixaban, two patients (11.1%) to warfarin, one patient to rivaroxaban. Two were not able to transition secondary to mortality. Upon follow‐up, 39% (n=7) had resolution of thrombus on repeat imaging, 11 (61%) did not undergo repeat imaging. Conclusion The use of heparin drip in acute ischemic strokes associated with intracranial sub‐occlusive thrombus could be an effective and safe treatment. However, in our study, it was not a predictor of good outcome at 90 days. Further studies with bigger samples are needed to evaluate the effectiveness of intravenous heparin in those patients.