Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

Autor: David Hasan, Edgar A. Samaniego, Jorge A Roa, Mario Zanaty, Emilee Gibson, Pascal Jabbour, Santiago Ortega-Gutierrez, Daichi Nakagawa
Rok vydání: 2018
Předmět:
Male
Time Factors
Databases
Factual
Haemoglobin levels
Blood volume
030204 cardiovascular system & hematology
0302 clinical medicine
Risk Factors
Platelet
Aged
80 and over
Dual Anti-Platelet Therapy
Endovascular Procedures
Tirofiban
Heparin
Middle Aged
Embolization
Therapeutic
Treatment Outcome
Original Article
Female
Stents
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.drug
Adult
medicine.medical_specialty
Subarachnoid hemorrhage
subarachnoid hemorrhage
Asymptomatic
Risk Assessment
03 medical and health sciences
Young Adult
Thromboembolism
medicine
Humans
cardiovascular diseases
Aged
Cerebral Hemorrhage
Retrospective Studies
business.industry
Intracranial Aneurysm
medicine.disease
dual antiplatelet therapy
Surgery
Concomitant
Neurology (clinical)
business
intracranial hemorrhage
030217 neurology & neurosurgery
Platelet Aggregation Inhibitors
Zdroj: Stroke and Vascular Neurology
ISSN: 2059-8696
Popis: BackgroundEndovascular treatment of intracranial aneurysms usually involves stent-assisted coiling (SAC) and flow diverters. Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy (DAPT) are required to prevent thromboembolic complications afterwards. We sought to determine the safety of tirofiban and DAPT in these cases.MethodsWe conducted a retrospective analysis of our database for patients with intracranial aneurysms who underwent SAC or flow diversion. The tirofiban-DAPT protocol used is described. Data regarding duration of infusion, placement of external ventricular devices (EVDs), complications, haemoglobin levels and platelet count before and 24 hours after antiplatelet therapy were collected and analysed.ResultsOne-hundred and forty-one patients with 148 aneurysms/procedures were included. 110 aneurysms were treated acutely and 38 electively. Minor and major haemorrhagic events were recognised in 20% (30/148) aneurysms. Only 5 (3.4%) intracerebral haemorrhages were symptomatic: 3 cortical/SAH and 2 EVD-related. The average blood volume in symptomatic haemorrhages was 24.8 cc versus 5.42 cc in asymptomatic haemorrhages (p=0.002). The rate of EVD-related haemorrhages was 15.7% (19/121) and only 2 (1.7%) were symptomatic. Most haemorrhagic events occurred in ruptured aneurysms (90.1%, p=0.01). No significant change in platelet count or haemoglobin levels before and 24 hours after administration of tirofiban and DAPT was documented. Concomitant administration of heparin did not increase haemorrhagic events.ConclusionThe use of the GP IIb/IIIa inhibitors tirofiban and DAPT in this series was safe. Tirofiban and DAPT did not affect platelet count or haemoglobin levels and did not increase rate of symptomatic haemorrhages or thromboembolic complications.
Databáze: OpenAIRE
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