Journal article
Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms
Stroke and vascular neurology, Vol.4(1), pp.36-42
03/2019
DOI: 10.1136/svn-2018-000192
PMCID: PMC6475079
PMID: 31105977
Abstract
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.
Details
- Title: Subtitle
- Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms
- Creators
- Edgar A Samaniego - Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAEmilee Gibson - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USADaichi Nakagawa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASantiago Ortega-Gutierrez - Department of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAJorge A Roa - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAPascal Jabbour - Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USADavid M Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Stroke and vascular neurology, Vol.4(1), pp.36-42
- DOI
- 10.1136/svn-2018-000192
- PMID
- 31105977
- PMCID
- PMC6475079
- NLM abbreviation
- Stroke Vasc Neurol
- ISSN
- 2059-8688
- eISSN
- 2059-8696
- Grant note
- DOI: 10.13039/100008951, name: Medicure
- Language
- English
- Date published
- 03/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984040353302771
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