ABSTRACT NUMBER: ESOC2026A1880 FEASIBILITY AND SAFETY CONSIDERATIONS OF ENDOVASCULAR THROMBECTOMY IN ACTIVE CANCER PATIENTS WITH THROMBOCYTOPENIA

Abstract Background and aims Thrombocytopenia is common in active cancer patients with large vessel occlusion (LVO), raising safety concerns regarding endovascular thrombectomy (EVT). We evaluated the safety and clinical outcomes of EVT in active cancer patients with thrombocytopenia versus those with normal platelet counts. Methods In this multicenter retrospective study (2017–2024), active cancer patients undergoing EVT for LVO were classified by thrombocytopenia (<150×109/L). All with moderate-to-severe thrombocytopenia (<100×109/L, n = 14) received 6 units of platelet transfusion. Propensity score matching (PSM) balanced baseline characteristics. Primary endpoints were hemorrhagic complications and 3-month outcomes. Results Among 98 patients, PSM yielded 40 matched pairs. Hemorrhagic outcomes were similar: any hemorrhagic transformation occurred in 35% of both groups (p > 0.99), and symptomatic intracranial hemorrhage (sICH) did not differ (p > 0.99). At 90 days, thrombocytopenic patients showed poorer functional status (median mRS 6 [IQR 3–6] vs 3 [IQR 1–6]; p = 0.029). However, in multivariable models, thrombocytopenia was not independently associated with hemorrhagic events or 90-day outcomes. Conversely, first-pass effect (FPE) independently predicted both lower mortality (adjusted OR [aOR] 0.153; p = 0.008) and favorable outcome (aOR 6.353; p = 0.003). Systemic metastasis predicted 3-month mortality (aOR 5.501; p = 0.003), while initial D-dimer levels were linked to favorable outcomes (aOR 0.925; p = 0.046). Conclusions In active cancer patients undergoing EVT, thrombocytopenia managed with peri-procedural platelet transfusion was not independently associated with hemorrhagic or functional outcomes. Optimizing FPE may be key in this high-risk population. Conflict of interest nothing to disclose