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Background <p>Risk stratification after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) remains challenging. We assessed whether post-EVT <span>d</span>-dimer is associated with outcomes.</p> Methods <p>This post hoc analysis included 881 MARVEL trial (82 centers in China) patients and plasma <span>d</span>-dimer measurement within 48&#xa0;h after EVT. Post-EVT <span>d</span>-dimer was analyzed as tertiles (T1 &lt; 0.8&#xa0;mg/L; T2 0.8–2.6&#xa0;mg/L; T3 &gt; 2.6&#xa0;mg/L), as a continuous variable, and as a log2-transformed continuous variable. The primary outcome was functional independence (90-day modified Rankin Scale [mRS] 0–2). Secondary outcomes were 90-day mRS shift, symptomatic intracranial hemorrhage (sICH) within 48&#xa0;h, and 90-day mortality. Associations were examined using adjusted logistic and ordinal logistic models.</p> Results <p>Higher post-EVT <span>d</span>-dimer was independently associated with lower odds of mRS 0–2. In Model 1, each doubling of post-EVT <span>d</span>-dimer was associated with lower odds of mRS 0–2 (adjusted odds ratio [aOR], 0.75; 95% CI 0.68–0.82; <i>p</i> &lt; 0.001). Compared with T1, odds of mRS 0–2 were lower in T2 (aOR, 0.49; 95% CI 0.34–0.71; <i>p</i> &lt; 0.001) and T3 (aOR, 0.33; 95% CI 0.22–0.49; <i>p</i> &lt; 0.001). Higher <span>d</span>-dimer was associated with a less favorable 90-day mRS distribution (adjusted common odds ratio, 0.74; 95% CI 0.69–0.79;<i> p</i> &lt; 0.001), higher sICH risk (aOR, 1.47; 95% CI 1.29–1.67; <i>p</i> &lt; 0.001), and higher mortality (aOR, 1.41; 95% CI 1.27–1.56; <i>p</i> &lt; 0.001). Baseline National Institutes of Health Stroke Scale (NIHSS) modified the association with mRS 0–2 (<i>p</i> <sub>for interaction</sub> = 0.006), with stronger associations when NIHSS &gt; 19.</p> Conclusions <p>Post-EVT <span>d</span>-dimer within 48&#xa0;h was associated with worse functional outcomes, higher sICH risk, and increased mortality after EVT for LVO stroke.</p> <p><i>Trial registration</i> Chinese Clinical Trial Registry; Identifier: ChiCTR2100051729. Registered on October 1, 2021.</p>

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Post-endovascular thrombectomy d-dimer and outcomes in anterior circulation large-vessel occlusion stroke: a post hoc analysis of MARVEL trial

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  • 发表日期：

    2026年8月4日

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  • Xuanyu Chen,
  • Jie Yang,
  • Chengsong Yue,
  • Linyu Li,
  • Wei Ma,
  • Shihai Yang,
  • Guojian Liu,
  • Dahong Yang,
  • Wenzhe Sun,
  • Gaoming Li,
  • Lilan Wang,
  • Shitao Fan,
  • Wenjie Zi,
  • Kunxin Lin

摘要

Background

Risk stratification after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO) remains challenging. We assessed whether post-EVT d-dimer is associated with outcomes.

Methods

This post hoc analysis included 881 MARVEL trial (82 centers in China) patients and plasma d-dimer measurement within 48 h after EVT. Post-EVT d-dimer was analyzed as tertiles (T1 < 0.8 mg/L; T2 0.8–2.6 mg/L; T3 > 2.6 mg/L), as a continuous variable, and as a log2-transformed continuous variable. The primary outcome was functional independence (90-day modified Rankin Scale [mRS] 0–2). Secondary outcomes were 90-day mRS shift, symptomatic intracranial hemorrhage (sICH) within 48 h, and 90-day mortality. Associations were examined using adjusted logistic and ordinal logistic models.

Results

Higher post-EVT d-dimer was independently associated with lower odds of mRS 0–2. In Model 1, each doubling of post-EVT d-dimer was associated with lower odds of mRS 0–2 (adjusted odds ratio [aOR], 0.75; 95% CI 0.68–0.82; p < 0.001). Compared with T1, odds of mRS 0–2 were lower in T2 (aOR, 0.49; 95% CI 0.34–0.71; p < 0.001) and T3 (aOR, 0.33; 95% CI 0.22–0.49; p < 0.001). Higher d-dimer was associated with a less favorable 90-day mRS distribution (adjusted common odds ratio, 0.74; 95% CI 0.69–0.79; p < 0.001), higher sICH risk (aOR, 1.47; 95% CI 1.29–1.67; p < 0.001), and higher mortality (aOR, 1.41; 95% CI 1.27–1.56; p < 0.001). Baseline National Institutes of Health Stroke Scale (NIHSS) modified the association with mRS 0–2 (p for interaction = 0.006), with stronger associations when NIHSS > 19.

Conclusions

Post-EVT d-dimer within 48 h was associated with worse functional outcomes, higher sICH risk, and increased mortality after EVT for LVO stroke.

Trial registration Chinese Clinical Trial Registry; Identifier: ChiCTR2100051729. Registered on October 1, 2021.