Endovascular thrombectomy in selected patients with active cancer and thrombocytopenia: outcomes under an institutional platelet transfusion practice

초록

Background and purpose Thrombocytopenia is common in patients with active cancer and large vessel occlusion (LVO), raising safety concerns regarding endovascular thrombectomy (EVT). Therefore, we compared the procedural safety and clinical outcomes of EVT between patients with active cancer with and without thrombocytopenia. Methods This retrospective multicenter study analyzed patients with active cancer who underwent EVT for anterior-circulation LVO between 2017 and 2024. Patients were categorized according to the presence of thrombocytopenia (<150 & times; 10(9)/L). All patients with moderate-to-severe thrombocytopenia (<100 & times; 10(9)/L, n = 14) received a transfusion of 6 units of platelet concentrates. Propensity score matching (PSM) was used to balance baseline characteristics. The primary endpoint was symptomatic intracranial hemorrhage (sICH). Secondary endpoints included any hemorrhagic transformation (HT) and 3-month clinical outcomes, including modified Rankin Scale (mRS) distribution, favorable outcome (mRS 0-2), and mortality. Results Among 98 patients with active cancer undergoing EVT, PSM yielded 40 balanced pairs. Rates of hemorrhagic complications were numerically similar between the groups, with no statistically significant differences observed in HT (p > 0.99) or sICH (12.5% vs. 10%; p > 0.99). At 90 days, the thrombocytopenia group showed a worse functional status (median [mRS], 6 [interquartile range {IQR} 3-6] vs. 3 [IQR 1-6]; p = 0.029), with nonsignificant trends toward fewer favorable outcomes (mRS 0-2: 17.5% vs. 37.5%; p = 0.080) and higher mortality (55% vs. 37.5%; p = 0.179). However, adjusted Firth penalized logistic regression analyses using baseline characteristics as covariates showed that thrombocytopenia was not significantly associated with hemorrhagic complications. In an exploratory analysis of post-EVT clinical outcomes, FPE was associated with lower 3-month mortality (adjusted OR, 0.153; p = 0.008) and favorable outcome (adjusted OR, 6.353; p = 0.003). Conclusion In this exploratory study of selected patients with active cancer undergoing EVT for anterior-circulation LVO, thrombocytopenia was not associated with a statistically demonstrable increase in hemorrhagic complications. However, these findings should be interpreted cautiously because of limited event numbers, residual confounding, and the absence of an untreated thrombocytopenic comparator group.

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