Abstract TP200: Anticoagulation Use and Endovascular Thrombectomy in Patients With Large Core Stroke - A Secondary Analysis of SELECT2 Trial
Bibliographic record
Abstract
Introduction: Anticoagulation (AC) use is common in patients presenting with acute ischemic stroke and is known to pose challenges to acute reperfusion therapy. However, evidence about association of AC use prior to stroke with endovascular thrombectomy outcomes and post-procedure hemorrhages, especially in those with large strokes is limited. Methods: From SELECT2, patients were stratified based on AC medication use and prior to stroke. Functional outcomes at 90day follow-up and hemorrhagic transformation on follow-up imaging were compared between patients with and without AC in adjusted regression models. Results: Of 352 patients, 29/180 (16%, VKA - 15, DOACs 14) EVT patients and 18/172 (10%, VKA - 3, DOACs 15) MM patients were receiving anticoagulants at baseline. AC patients were older (72 (62-79) y vs 66 (58-75) y), with higher cardiac morbidity (Congestive Heart Failure: 28% vs 10%, Atrial Fibrillation: 70% vs 17%), but had similar NIHSS [20 (16-24) vs 18 (15-23)], time to randomization [511 (350-909) vs 586 (326-920) minutes], CT ASPECTS [4 (3-5) vs 4 (3-5)] and ischemic core estimates [91 (71 -110) vs 103 (71-139) ml, AC vs nonAC respectively]. Within AC patients, EVT did not improve outcomes (Shift: 6 (4-6) vs 5 (4-6), aGenOR: 0.89 (0.53-1.50), mRS 0-3: 11% vs 14%, aRR: 1.27 (0.40-4.05), mRS 5-6: 69% vs 67%, aRR: 1.05 (0.73-1.50)]. Furthermore, EVT patients on AC reported numerically higher rates of any intracerebral hemorrhage [85.7% vs 70.2%, aRR: 1.18, 95% CI: 0.98-1.43], but no sICH or parenchymal hemorrhage and demonstrated worse outcome [median mRS: 6 (4-6) vs 4 (3-6), aGenOR: 0.49(0.32-0.74)], mRS 0-3: 14% vs 43%, aRR: 0.36 (0.15-0.86)], and mRS 5-6: 69% vs 43%, aRR: at 90 day follow-up and numerically lower functional independence (mRS 0-2) [3.4% vs 23.3%, aRR: 0.18(0.03-1.21)], AC vs nonAC respectively. Consistent results were observed in patients achieving successful reperfusion. Conclusion: Almost 1/7 th of patients presenting with large stroke in SELECT2 trial demonstrated AC use at baseline, with higher cardiac morbidity. These patients were more likely to have hemorrhagic outcomes and worse clinical outcomes after EVT and successful reperfusion. Clinicaltrials.gov registration: NCT03876457
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".