Effect of Premorbid Antiplatelet Medication Use on Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-matched Study

Enríquez-Marulanda, Alejandro; Salem, Mohamed M; Ravindran, Krishnan; Ascanio, Luis C; Maragkos, Georgios A; Gomez-Paz, Santiago; Alturki, Abdulrahman Y.; Ogilvy, Christopher S.; Thomas, Ajith J.; Moore, Justin M.

doi:10.7759/cureus.5603

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…66 On the other hand, a recent systematic review in which the majority of cases were treated by coil embolization also showed a significant reduction in poor outcome. 67,68 Although a recent retrospective study showed that double antiplatelet therapy might be effective, a large-scale RCT will be required to verify its significance. 69,70 As another treatment method for microthrombosis, there have been reports showing the effectiveness of ADAMTS13, which has an antiplatelet effect by inhibiting VWF-dependent platelet aggregation.…”

Section: Discussionmentioning

confidence: 99%

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Naraoka

Matsuda

Shimamura

et al. 2021

J Cereb Blood Flow Metab

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Early brain injury (EBI) is considered an important cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). As a factor in EBI, microcirculatory dysfunction has become a focus of interest, but whether microcirculatory dysfunction is more important than angiographic vasospasm (aVS) remains unclear. Using data from 128 cases, we measured the time to peak (TTP) in several regions of interest on digital subtraction angiography. The intracerebral circulation time (iCCT) was obtained between the TTP in the ultra-early phase (the baseline iCCT) and in the subacute phase and/or at delayed cerebral ischemia (DCI) onset (the follow-up iCCT). In addition, the difference in the iCCT was calculated by subtracting the baseline iCCT from the follow-up iCCT. Univariate analysis showed that DCI was significantly increased in those patients with a prolonged baseline iCCT, prolonged follow-up iCCT, increased differences in the iCCT, and with severe aVS. Poor outcome was significantly increased in patients with prolonged follow-up iCCT and increased differences in the iCCT. Multivariate analysis revealed that increased differences in the iCCT were a significant risk factor that increased DCI and poor outcome. The results suggest that the increasing microcirculatory dysfunction over time, not aVS, causes DCI and poor outcome after aneurysmal aSAH.

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Section: Discussionmentioning

confidence: 99%

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Naraoka

Matsuda

Shimamura

et al. 2021

J Cereb Blood Flow Metab

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“…DCI is the leading cause of disability in aSAH surviving the initial insult,19 and its exact pathogenesis is yet to be elucidated; inflammatory cascade activation and increased platelet aggregability have been implicated as potential underpinnings 20. Therefore, the role of AT in aSAH has been controversial, with conflicting results in the literature.…”

Section: Discussionmentioning

confidence: 99%

Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Takase

Tatezuki

Salem

et al. 2022

J NeuroIntervent Surg

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BackgroundEndovascular embolization using standalone coils is the preferred treatment option for ruptured cerebral aneurysms to avoid the use of dual antiplatelet therapy with stent coiling or endoluminal flow diversion devices. However, it has been reported that patients undergoing the standalone coiling approach are at risk for periprocedural thromboembolism. Therefore, this systematic review and meta-analysis was performed to clarify the risks and benefits of antiplatelet therapy (AT) during coiling procedures performed to treat ruptured aneurysms, including the incidence of early thromboembolic events, hemorrhagic and delayed ischemic events, as well as clinical outcomes.MethodsA comprehensive search of three databases was performed for articles from inception to June 2021. After fulfilling the inclusion criteria, five studies were included in this meta-analysis and 462 patients with aneurysmal subarachnoid hemorrhage (aSAH) were identified who underwent endovascular standalone coiling treatment. Aneurysm location, patient characteristics, and aSAH grades were comparable between the AT and non-AT groups.ResultsAT significantly decreased the incidence of thromboembolic events immediately after the coiling procedures compared with non-AT (OR 3.42; 95% CI 1.77 to 6.61, p<0.001). The incidences of hemorrhage, delayed ischemia, and clinical outcomes with or without AT were not significantly different between groups.ConclusionsAlthough this study showed no beneficial effect of AT on clinical outcomes, the results suggest that AT could be combined with standalone coiling to avoid thromboembolism during the perioperative period. A large prospective study and/or an additional meta-analysis would be required to further investigate how AT benefits standalone coil embolization in aSAH.

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“…Thus, nimodipine and acelysin can be considered important elements of drug therapy of subarachnoid hemorrhage, necessary for the prevention of secondary complications of a cerebral aneurysm rupture. Despite some positive experience of using these drugs in the treatment of subarachnoid hemorrhages [10,11,12], their influence on the mechanisms of brain cellular damage, reactiveness and death still remains insufficiently studied.…”

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confidence: 99%

The influence of acelysin and nimotop on the cellular response of the hippocampus during the dynamics of experimental subarachnoid hemorrhage

Polkovnikov,

Tertyshnyi

2023

Patologìâ

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Aim. Immunohistochemical study of rat hippocampal neurons and astrocytes at different time-points of experimental brain hemorrhage treated with acelysin and nimotop. Materials and methods. Subarachnoid hemorrhage (SAH) was modeled according to R. V. Dudhani et al. using 35 Wistar rats which were divided into 7 groups. Animals of the 1st and 2nd groups, for 4 and 7 days respectively received acelysin at a dose of 15 mg/kg once a day; animals of the 3rd and 4th groups received nimodipine at a dose of 0.3 mg/kg every 8 hours for 4 and 7 days. In groups 5th and 6th (control), SAH was modeled without treatment with observation periods of 4 and 7 days, respectively. The 7th group consisted of intact animals. Hippocampal CA1 fields were studied immunohistochemically evaluating the expression of CASP3, NeuN, GFAP by the relative area of immunostaining in ImageJ. Results. CASP3 expression in hippocampal neurons increases by 2.3 and 5.7 times on day 4 and by 1.8 and 3.9 times on day 7 of experimental SAH (groups 1–4) compared to intact group. GFAP expression increases in all observation groups compared to intact animals with the maximum values in the 5th group – by 8.14 times. The dynamics of NeuN expression in hippocampal neurons when using acelysin and nimotop corresponds to the inverse dynamics of CASP3 expression. The NeuN expression increases maximally on the 7th day of acelysin use and is equal to 91.76 % of the intact group values. Conclusions. The experimental SAH is accompanied by a change in the expression of CASP3, NeuN in neurons and GFAP in astrocytes. The use of acelysin and nimotop leads to decrease in CASP3 expression in hippocampal neurons on the 4th day by 3.82 and 1.54 times compared to control group, and on the 7th day by 4.00 and 1.84 times, respectively, which reflects the positive effect of the therapy on the prevention of apoptotic death of hippocampal neurons. Compared with nimotop, the use of acelicine significantly increases the expression of NeuN on day 4 and 7 – by 1.84 and 1.95 times, respectively, which indicates a more pronounced neuroprotective effect of acelysin on hippocampal neurons in SAH. Increased GFAP expression reflects the dynamic reactive remodeling of astrocytes, while the use of acelysin and nimotop does not affect the reduction of GFAP levels on days 4 and 7 of SAH and their return to baseline values. The results of the present experimental study provide a theoretical justification of the feasibility of including metabolitotropic drugs in the basic therapy of SAH.

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Effect of Premorbid Antiplatelet Medication Use on Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Propensity Score-matched Study

Cited by 3 publications

References 31 publications

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Role of microcirculatory impairment in delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

The influence of acelysin and nimotop on the cellular response of the hippocampus during the dynamics of experimental subarachnoid hemorrhage

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