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(Stroke. 2009;40:516.)
© 2009 American Heart Association, Inc.

Original Contributions

Safety and Efficacy of Endovascular Thrombectomy in Patients With Abnormal Hemostasis

Pooled Analysis of the MERCI and Multi MERCI Trials

Raul G. Nogueira, MD; Wade S. Smith, MD, PhD on Behalf of the MERCI and Multi MERCI Writing Committee

From the Departments of Vascular & Critical Care Neurology and Interventional Neuroradiology & Endovascular Neurosurgery (R.G.N.), Massachusetts General Hospital, Boston; and the Department of Neurology (W.S.S.), University of California, San Francisco.

Correspondence to Raul G. Nogueira, MD, Department of Interventional Neuroradiology & Endovascular Neurosurgery, Massachusetts General Hospital, 55 Fruit St, GRB-2-241, Boston, MA 02114. E-mail rnogueira{at}partners.org

Background and Purpose— Patients with abnormal hemostasis are not considered candidates for thrombolysis. We analyzed the MERCI/Multi MERCI cohort as an attempt to establish the risks and benefits of thrombectomy in this patient population.

Methods— Two patient groups were identified: Group 1 (n=35): patients with INR >1.7 or PTT >45 seconds or platelet count <100 000/µL; Group 2 (n=270): patients with INR 1.7, PTT 45 seconds, and platelet count 100 000/µL. Clinical, radiographic, and revascularization outcomes were subsequently compared.

Results— In Group 1, 20 patients had INR >1.7 (mean: 2.4; range: 1.8 to 4.9), 11 had PTT >45 seconds (mean: 95; range: 46 to 190), and 6 had platelets <100 000/µL (mean: 63 400; range: 16 000 to 94 000). Two patients had both INR >1.7 and PTT >45 seconds. The two groups did not significantly differ in terms of age, gender, baseline NIHSS scores, intraarterial thrombolytic use/dosage, or occlusion site. Time-to-treatment was slightly earlier in Group 1. There was no significant difference in the rates of revascularization (TIMI 2 to 3: 60% versus 65%), mortality (40% versus 38%), or major symptomatic intracranial hemorrhage (SICH; 8.6% versus 8.5%). Group 2 had higher rates of good clinical outcomes (9% versus 35%; P=0.002). This was likely related to a lower prestroke health status in Group 1 patients. In Group 1, successful revascularization was associated with improved outcomes (P=0.015) and lower mortality (24% versus 64%; P=0.033).

Conclusion— Patients with abnormal hemostasis who undergo thrombectomy do not appear to be at a higher risk for SICH but have lower rates of good outcomes. In this patient group, successful revascularization appears to be associated with improved clinical outcomes and lower mortality.

Key Words: acute stroke • anticoagulation • endovascular treatment • interventional neuroradiology intracerebral hemorrhage • intracranial hemorrhage • thrombolysis • thrombectomy • thrombocytopenia

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