Journal article
The Safety and Efficacy of Continuous Tirofiban as a Monoantiplatelet Therapy in the Management of Ruptured Aneurysms Treated Using Stent-Assisted Coiling or Flow Diversion and Requiring Ventricular Drainage
Neurosurgery, Vol.85(6), pp.E1037-E1042
12/01/2019
DOI: 10.1093/neuros/nyz226
PMCID: PMC8133353
PMID: 31298301
Abstract
Hemorrhagic complications are a major concern for aneurysmal subarachnoid hemorrhage patients treated with stenting or stent-assisted coiling and undergoing additional procedures such as shunting, ventriculostomy placement, and craniotomies/craniectomies.
To assess the safety and efficacy of using a continuous infusion of tirofiban as a monoantiplatelet therapy in the management of ruptured aneurysms in the setting of either stent-assisted coiling (SAC) or flow diversion devices (FDD) in patients requiring either an external ventricular drain (EVD) or ventriculoperitoneal shunt (VPS).
Aneurysmal subarachnoid hemorrhage (aSAH) patients between July 2017 and September 2018 who were treated with SAC or FDD were started on a continuous tirofiban infusion protocol (0.10 μg/kg/min) with no preceding loading dose as a monoantiplatelet therapy. Safety analysis was performed retrospectively to assess the complication rate, hemorrhagic rate, and rate of ischemic events. There were no hemorrhages related to the VPS surgery.
Nineteen subjects were included in the series. The patients received a total of 25 procedures that included 19 EVDs and 6 VPSs. Two patients (8.3%) developed small asymptomatic track hemorrhages after EVD placement. One patient developed a large retroperitoneal hemorrhage due to renal artery branch injury during procedure, and another patient developed an idiosyncratic transient thrombocytopenia which resolved after stopping the medication. One patient (4%) developed a transient ischemic attack, which resolved after a bolus of tirofiban.
Our study suggests that long-term use of intravenous tirofiban monotherapy in aSAH subjects for endovascular SAC or FDD is safe in the perioperative setting.
Details
- Title: Subtitle
- The Safety and Efficacy of Continuous Tirofiban as a Monoantiplatelet Therapy in the Management of Ruptured Aneurysms Treated Using Stent-Assisted Coiling or Flow Diversion and Requiring Ventricular Drainage
- Creators
- Kaustubh Limaye - Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, IowaMario Zanaty - Departmnet of Neurosurgery, University of Iowa, Iowa City, IowaJoseph Hudson - Departmnet of Neurosurgery, University of Iowa, Iowa City, IowaDaichi Nakagawa - Department of Neurosurgery, University of Tokyo, Tokyo, JapanSami Al Kasab - Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, IowaCarlos Alvarez - Departmnet of Neurosurgery, University of Iowa, Iowa City, IowaSudeepta Dandapat - Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa, Iowa City, IowaDavid K Kung - Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PennsylvaniaSantiago Ortega-Gutierrez - Department of Radiology, University of Iowa, Iowa City, IowaPascal Jabbour - Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PennsylvaniaEdgar A Samaniego - Department of Radiology, University of Iowa, Iowa City, IowaDavid Hasan - Departmnet of Neurosurgery, University of Iowa, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.85(6), pp.E1037-E1042
- Publisher
- United States
- DOI
- 10.1093/neuros/nyz226
- PMID
- 31298301
- PMCID
- PMC8133353
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Grant note
- T32 HL007344 / NHLBI NIH HHS
- Language
- English
- Date published
- 12/01/2019
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984070395302771
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