Abstract TMP8: Admission Hemoglobin Concentration and Outcome after Endovascular Thrombectomy in Large Vessel Occlusion Stroke

Background: After ischemic stroke, low and high hemoglobin levels have been shown to be detrimental in large epidemiologic studies. It is unclear whether admission hemoglobin levels have prognostic value in patients treated with endovascular thrombectomy (EVT). Methods: Consecutive anterior and posterior circulation stroke patients who presented for EVT were included in this retrospective analysis. Admission hemoglobin levels were divided into quintiles (Q1-Q5). Outcome measures included early neurologic deterioration (END), defined as an NIHSS increase of ≥ 4 points from admission to 24 hours, 90-day functional dependence (modified Rankin score >2) and 90-day mortality. Results: 970 EVT patients (554 male, mean ± SD age of 67 ± 15, mean ± SD admission hemoglobin level of 138 ± 18) were included. In binary logistic regression adjusting for potential confounders, low admission hemoglobin predicted functional dependence at day 90 (Q1 vs Q3 OR 1.63; 95% CI 1.01 - 2.62, p=0.04) but did not predict END or death at day 90. High admission hemoglobin levels predicted END (Q5 vs Q3 OR 2.54 95%CI 1.20- 5.37, p= 0.01), death at day 90 (Q5 vs Q3 OR 3.11 95% CI 1.50 - 6.41, p=0.002) as well as a trend towards increased functional dependence at day 90 (Q5 vs Q3 OR 1.51 95% CI 0.93- 2.44, p=0.10). The increased mortality with elevated hemoglobin was apparent within the first week after stroke. Conclusion: In stroke patients treated with EVT, both low and high admission hemoglobin levels are associated with worse patient outcomes. Optimizing hemoglobin levels may be a therapeutic target in large vessel occlusion stroke.