Neurology and Therapy (Apr 2025)

The Mediating Effect of Intracranial Hemorrhage Status on the Relationship between the INR and Mortality in Patients with Ischemic Stroke

  • Yapeng Guo,
  • Lingshan Wu,
  • Zhenxuan Tian,
  • Xu Xu,
  • Jinfu Ma,
  • Changwei Guo,
  • Linyu Li,
  • Jie Yang,
  • Wenjie Zi,
  • Jiacheng Huang,
  • Xianjun Huang

DOI
https://doi.org/10.1007/s40120-025-00715-z
Journal volume & issue
Vol. 14, no. 3
pp. 881 – 894

Abstract

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Abstract Introduction The international normalized ratio (INR) is a biomarker of coagulopathy. The objective of this study was to assess the relationship between the INR and clinical outcomes in patients with large vessel occlusion (LVO) stroke who received endovascular therapy. Methods The RESCUE BT trial was a multicenter, randomized, double-blind, placebo-controlled clinical trial involving 948 stroke patients from 55 centers across China. We extracted INR data and related data from the BT database, with outcome measures comprising intracranial hemorrhage (ICH) and 90-day mortality. Logistic regression analysis was conducted to examine the associations between the INR and clinical outcomes in the entire patient cohort and across different stratified subgroups. Results A total of 885 patients met the study criteria, with 672 exhibiting a normal INR and 213 showing an elevated INR. Multivariable analysis indicated that an elevated INR was linked to an increased risk of ICH (OR 1.65, 95% confidence interval CI 1.17–2.33, P =0.005) and 90-day mortality (OR 1.78, 95% CI 1.17–2.70, P =0.007). Mediation analysis indicated that the association between the INR and 90-day mortality risk was partially mediated by ICH status, with the mediation effect contributing 11.4% to the overall relationship. Subgroup analyses revealed no significant differences between the different subgroups (P for interaction > 0.05). In patients receiving tirofiban, an elevated INR was more strongly associated with an increased 90-day mortality rate (OR 7.75, 95% CI 1.42–42.33, P =0.018). Conclusion Our findings underscore the critical importance of INR monitoring in patients with LVO stroke undergoing endovascular treatment (EVT). The association between the INR and 90-day mortality was mediated through ICH status. The use of tirofiban strengthened the associated between an elevated INR and a higher 90-day mortality rate. These insights offer valuable guidance for optimizing patient outcomes. Trial Registration URL: http://www.chictr.org.cn ; ChiCTR-INR-17014167.

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