Influence of Thrombocytopenia on the Outcome of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

Mirjana Ždraljević; Tatjana Pekmezović; Predrag Stanarčević; Ivan Vukašinović; Ivana Berisavac; Marko Ercegovac; Filip Vitošević; Dragoslav Nestorović; Vladimir Cvetić; Višnja Padjen; Maja Stefanović- Budimkić; Tamara Švabić Medjedović; Dejana R Jovanović

doi:10.1016/j.jstrokecerebrovasdis.2021.106240

Influence of Thrombocytopenia on the Outcome of Mechanical Thrombectomy in Patients with Acute Ischemic Stroke

J Stroke Cerebrovasc Dis. 2022 Feb;31(2):106240. doi: 10.1016/j.jstrokecerebrovasdis.2021.106240. Epub 2021 Dec 13.

Affiliations

¹ Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia.
² Institute of Epidemiology, Faculty of Medicine, Višegradska Street 26, 11 000 Belgrade, Serbia.
³ Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia.
⁴ Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia.
⁵ Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia; Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Dr Koste Todorovića Street 6, 11 000 Belgrade, Serbia.
⁶ Neurology Clinic, University Clinical Center of Serbia, Dr Subotica Street 6, 11 000 Belgrade, Serbia; Faculty of Medicine, Dr Subotica Street 8, 11 000 Belgrade, Serbia. Electronic address: dejana.jovanovic@med.bg.ac.rs.

PMID: 34915307
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106240

Abstract

Objectives: Mechanical thrombectomy (MT) has become leading treatment option for acute ischemic stroke (AIS) due to large vessels occlusion (LVO). Platelet counts may affect outcome in patients with AIS or transient ischemic attack. The aim of our study was to determine the influence of thrombocytopenia on the safety and efficacy of MT in patients with AIS due to anterior circulation LVO.

Materials and methods: This study included 127 consecutive adult patients with AIS due to anterior circulation LVO who underwent MT. The patients were divided into 2 groups based on initial platelet count: with thrombocytopenia (<150 × 10⁹/L) and without thrombocytopenia (≥150 × 10⁹/L). Primary safety outcome was symptomatic intracerebral haemorrhage (SICH), while secondary safety outcome was stroke-related mortality. Efficacy outcome was functional independence, defined as modified Rankin Scale (mRS) score 0-2. Follow- up time was 90 days.

Results: Initial thrombocytopenia (<150 × 10⁹/L) was detected in 19 (15%) patients. Multivariable analysis showed that initial thrombocytopenia did not increase the risk of SICH and did not affect the short-term functional outcome (p = 0.587). However, initial thrombocytopenia increased the risk for stroke-related mortality (aOR 3.639, 95% CI 1.079-12.641, p = 0.037). The main cause of mortality in the group with thrombocytopenia was malignant cerebral infarction (44.4%).

Conclusions: Thrombocytopenia does not affect the efficacy and the risk of SICH in patients with AIS caused by anterior circulation LVO treated with MT. However, the risk of mortality is higher in patients with thrombocytopenia, mainly due to malignant cerebral infarction.

Keywords: acute ischemic stroke; functional outcome; mechanical thrombectomy; mortality; thrombocytopenia.

MeSH terms

Adult
Humans
Ischemic Stroke* / therapy
Mechanical Thrombolysis* / adverse effects
Thrombocytopenia* / epidemiology
Treatment Outcome