Safety of Mechanical Thrombectomy for Acute Ischemic Stroke in Patients on Novel Oral Anticoagulants (P1.196)

Objective: To compare the safety of mechanical thrombectomy in AIS patients who were on vitamin K antagonists (Warfarin) versus those on novel oral anticoagulants (NOAC). Background: AIS patients who were on anticoagulation are traditionally not considered for IV r-tPA as safety of the treatment is not well established. Mechanical thrombectomy has now shown to be efficacious in AIS patients with large vessel occlusion (LVO) but the safety of this treatment on NOACs is unknown. We compared the safety of mechanical thrombectomy in AIS patients who did not receive IV r-tPA who were on vitamin K antagonists or NOAC. Methods: This is a retrospective analysis of consecutive AIS patients receiving mechanical thrombectomy who were on warfarin or NOAC in our tertiary academic medical center. Patients who were on warfarin and received IV r-tPA were excluded from the study. The primary outcomes included intracranial hemorrhage (ICH) seen in 24 hour follow up CT scan and symptomatic ICH (sICH) measured by any deterioration in National Institute of Health stroke scale (NIHSS). Chi square test was used for statistical analysis. Results: From 2008 until Sept 2015, 16 patients were on warfarin with mean INR of 2.1±1.6 and the rate of sICH was 6.25[percnt](1/16). During the same period, 14 patients were on NOAC, out of these 21.4 [percnt] (4/14) had SICH. No statistically significant difference was found in the rate of ICH between the two groups p=0.22. The overall rate of complications other than sICH was also not different in the two groups. Conclusion: Patients on NOAC undergoing mechanical thrombectomy show a trend towards increased sICH compared to the warfarin group. This may warrant larger studies of safety of mechanical thrombectomy in the presence of NOACs. Disclosure: Dr. Sharma has nothing to disclose. Dr. Atchaneeyasakul has nothing to disclose. Dr. Ziayee has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Guada has nothing to disclose. Dr. Khandelwal has nothing to disclose. Dr. Ramdas has nothing to disclose. Dr. Yavagal has received personal compensation for activities with Covidien/evV3 as a consultant and Steering Committee Member.