Abstract 3207: Pre-procedural International Normalized Ratio and Hemorrhagic Complications associated with Neurointerventional Procedures
Background: Pre-procedural elevated international normalized ratio (INR) is associated with higher bleeding complication but the role of INR elevation in determining the rate of bleeding complications in minimally invasive neurointerventional procedures is not known.
Methods: We retrospectively analyzed the rates of hemorrhagic complications associated with consecutive neurointerventional procedures at two comprehensive stroke centers from July 2009 through June 2011. Patients with hemorrhage prior to the procedure were excluded. We ascertained any intra or extracranial hemorrhagic complications within 24 hours of the procedure. The severity of hemorrhagic complications were classified according to the Global Use of Strategiesto Open Occluded Coronary Arteries (GUSTO) classification into severe or life-threatening (either intracranial hemorrhage or bleeding that causes hemodynamic compromise and requires intervention); moderate (bleeding that requires blood transfusion but does not result in hemodynamic compromise); and mild (bleeding that does not meet criteria for either severe or moderate bleeding).
Results: A total of 551 procedures were reviewed (49% women, mean age [≠SD] 56±17 years). The procedures performed included mechanical thrombectomy/intra-arterial thrombolysis (n=87), endovascular treatment of cerebral vasospasm (n=84), carotid artery angioplasty/stent placement (n=82), aneurysm embolization (n=65), intracranial angioplasty/stent placement (n=47), extracranial vertebral angioplasty/stent (n=29), tumor embolization (n=23), AVM embolization (n=20), and other procedures (n=114). Of these procedures, 21 procedures were performed in patients with pre-procedure INR of 1.5 or greater. After The rates of severe or life-threatening bleeding was higher in patients with pre-procedural INR greater than or equal to 1.5 compared with those with pre-procedural INR less than 1.5 (24% vs. 7.0%, p=0.0165). After adjusting for age and gender, the difference between the groups remained statistically significant (odds ratio 3.80, 95% CI 1.27-11.375). The rates of moderate and minor bleeding complications were similar in patients stratified by pre-procedure INR.
Conclusions: Our study demonstrates that patients who undergo neurointerventional procedures with pre-procedure INR of 1.5 or greater have a three-fold higher risk of severe or life-threatening bleeding and neurointerventional procedures should be avoided.
- © 2012 by American Heart Association, Inc.