GLP-1 receptor agonists linked to 67% lower mortality after acute ischemic stroke thrombectomy

Acute ischemic stroke (AIS) is a leading cause of death and disability, with endovascular thrombectomy (EVT) being a critical intervention for large vessel occlusion. Despite EVT, patients still face substantial risks of long-term mortality and rehospitalization. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated significant cardiovascular and cerebrovascular benefits in high-risk populations, primarily in patients with type 2 diabetes and obesity, by reducing atherosclerotic events. However, their specific impact on post-EVT outcomes in AIS patients, a population with unique acute physiological stressors, has remained largely unexplored, representing a crucial knowledge gap.

Researchers conducted a retrospective cohort analysis using the TriNetX Network, identifying adults (≥18 years) diagnosed with AIS and treated with EVT between January 1, 2016, and December 31, 2025. The study defined the exposure cohort as patients with any GLP-1A exposure within three months prior to EVT, while comparators had no such exposure. This pre-index window aimed to mitigate immortal time bias. Follow-up for both cohorts commenced on the EVT date, with primary endpoints being all-cause mortality and inpatient hospitalizations over a three-year period. A one-to-one propensity score matching was applied, accounting for demographics, comorbidities, medications, and metabolic variables like National Institute of Health Stroke Scale scores, Hemoglobin A1c, and body mass index to ensure balanced groups.

From an initial pool of 286 GLP-1A-exposed and 19,263 unexposed EVT-treated patients, the analysis focused on 261 well-matched pairs. GLP-1A exposure was significantly associated with improved 3-year outcomes. All-cause mortality was substantially lower in the GLP-1A group, recorded at 11.5% compared to 29.9% in the unexposed group (Hazard Ratio [HR] 0.334, 95% CI 0.219-0.508). This represents a 67% reduction in mortality risk. Inpatient hospitalizations were also significantly reduced in the GLP-1A cohort, occurring in 39.8% of patients versus 54.8% in the unexposed group (HR 0.514, 95% CI 0.398-0.663). Both findings were highly statistically significant, with p-values of <0.001. These results suggest a protective effect of prior GLP-1A use on long-term survival and healthcare utilization post-EVT.

GLP-1A use was associated with a 67% reduction in all-cause mortality (11.5% vs 29.9%, HR 0.334, p < 0.001) and a 27% reduction in inpatient hospitalizations (39.8% vs 54.8%, HR 0.514, p < 0.001) over three years post-EVT.