The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey
Abstract Background The total amount of heparin administered through flush fluids in stroke patients is not considered in recent trials, possibly influencing main results. We investigated the use of heparin among treating physicians worldwide. Methods We conducted a survey from November 2022 to Janu...
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SpringerOpen
2025-03-01
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| Series: | CVIR Endovascular |
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| Online Access: | https://doi.org/10.1186/s42155-025-00532-3 |
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| author | Senta Frol Faysal Benali Aymeric Rouchaud Robrecht R. M. M. Knapen Wim H. van Zwam Research Committee of the European Society of Minimally Invasive Neurological Therapy (ESMINT) |
| author_facet | Senta Frol Faysal Benali Aymeric Rouchaud Robrecht R. M. M. Knapen Wim H. van Zwam Research Committee of the European Society of Minimally Invasive Neurological Therapy (ESMINT) |
| author_sort | Senta Frol |
| collection | DOAJ |
| description | Abstract Background The total amount of heparin administered through flush fluids in stroke patients is not considered in recent trials, possibly influencing main results. We investigated the use of heparin among treating physicians worldwide. Methods We conducted a survey from November 2022 to January 2023 to identify the variability of heparin administration during stroke endovascular treatment (EVT). We calculated the total heparin dose per hour (IU/h) by adding the intravenous (IV)-bolus dose to the amount administered through flush fluids, calculated by a multiplication of the number of infusion bags, drip rate[mL/h] and heparin concentration[IU/L]. Results A total of 315 participants from different countries worldwide completed the survey and 231/315(73%) respondents administer heparin during EVT. The majority administered heparin only through flush fluids (168/231; 72.7%), followed by both IV-bolus and flush fluids (36/231; 16%), and those who used only an IV-bolus (27/231; 11.7%). From the participants that administer heparin through flush fluids, the median heparin concentration was 2000 IU/L (range:100 IU/L-10000 IU/L). The total heparin dose (administered through flush fluids and IV-bolus) among 23 respondents showed a median of 4650 IU/h (IQR:3432–5900). Among the respondents who administer heparin through IV-bolus only, the median was 5250 IU (IQR:3750–7500). Conclusion This survey revealed variable heparin doses administered by physicians worldwide during EVT and reflects the lack of international guidelines. Caution is warranted, specifically during complex/long EVT procedures. Furthermore, heparin flush doses should be considered in future trials regarding periprocedural anticoagulants, since imbalances could potentially confound results. |
| format | Article |
| id | doaj-art-75b5b863e1f14a628e7754e6e4ada263 |
| institution | OA Journals |
| issn | 2520-8934 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | CVIR Endovascular |
| spelling | doaj-art-75b5b863e1f14a628e7754e6e4ada2632025-08-20T01:57:48ZengSpringerOpenCVIR Endovascular2520-89342025-03-01811710.1186/s42155-025-00532-3The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide surveySenta Frol0Faysal Benali1Aymeric Rouchaud2Robrecht R. M. M. Knapen3Wim H. van Zwam4Research Committee of the European Society of Minimally Invasive Neurological Therapy (ESMINT)Department of Vascular Neurology, University Medical Center LjubljanaDepartment of Radiology, AZ VesaliusDepartment of Interventional Neuroradiology, Univ Limoges, XLIM, CNRS Umr7252. Limoges University HospitalDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and CARIM, School for Cardiovascular Diseases, Maastricht UniversityDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Center+ and CARIM, School for Cardiovascular Diseases, Maastricht UniversityAbstract Background The total amount of heparin administered through flush fluids in stroke patients is not considered in recent trials, possibly influencing main results. We investigated the use of heparin among treating physicians worldwide. Methods We conducted a survey from November 2022 to January 2023 to identify the variability of heparin administration during stroke endovascular treatment (EVT). We calculated the total heparin dose per hour (IU/h) by adding the intravenous (IV)-bolus dose to the amount administered through flush fluids, calculated by a multiplication of the number of infusion bags, drip rate[mL/h] and heparin concentration[IU/L]. Results A total of 315 participants from different countries worldwide completed the survey and 231/315(73%) respondents administer heparin during EVT. The majority administered heparin only through flush fluids (168/231; 72.7%), followed by both IV-bolus and flush fluids (36/231; 16%), and those who used only an IV-bolus (27/231; 11.7%). From the participants that administer heparin through flush fluids, the median heparin concentration was 2000 IU/L (range:100 IU/L-10000 IU/L). The total heparin dose (administered through flush fluids and IV-bolus) among 23 respondents showed a median of 4650 IU/h (IQR:3432–5900). Among the respondents who administer heparin through IV-bolus only, the median was 5250 IU (IQR:3750–7500). Conclusion This survey revealed variable heparin doses administered by physicians worldwide during EVT and reflects the lack of international guidelines. Caution is warranted, specifically during complex/long EVT procedures. Furthermore, heparin flush doses should be considered in future trials regarding periprocedural anticoagulants, since imbalances could potentially confound results.https://doi.org/10.1186/s42155-025-00532-3HeparinEndovascular treatmentStroke |
| spellingShingle | Senta Frol Faysal Benali Aymeric Rouchaud Robrecht R. M. M. Knapen Wim H. van Zwam Research Committee of the European Society of Minimally Invasive Neurological Therapy (ESMINT) The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey CVIR Endovascular Heparin Endovascular treatment Stroke |
| title | The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey |
| title_full | The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey |
| title_fullStr | The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey |
| title_full_unstemmed | The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey |
| title_short | The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey |
| title_sort | variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment a world wide survey |
| topic | Heparin Endovascular treatment Stroke |
| url | https://doi.org/10.1186/s42155-025-00532-3 |
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