Hemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis

Hudson, Joseph S.; Nagahama, Yasunori; Nakagawa, Daichi; Starke, Robert M.; Dlouhy, Brian J.; Torner, James C.; Jabbour, Pascal; Allan, Lauren; Derdeyn, Colin P.; Greenlee, Jeremy D.W.; Hasan, David

doi:10.3171/2017.5.jns17642

Cited by 40 publications

(22 citation statements)

References 18 publications

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“…With regard to DAPT, two recent studies by Hudson et al demonstrate a higher risk for radiographic hemorrhage associated with external ventricular drain or VP shunt placement in aSAH patients requiring DAPT due to stent-assisted coiling or flow diversion. However, the risk of clinically significant bleeding complications was considered low [21,22]. A recent meta-analysis [5] reported that ventriculostomy-related bleeding rates were significantly higher among patients receiving APT and that the rate of major hemorrhage was higher after DAPT compared with single APT.…”

Section: Discussionmentioning

confidence: 99%

Effects of post-interventional antiplatelet therapy on angiographic vasospasm, delayed cerebral ischemia, and clinical outcome after aneurysmal subarachnoid hemorrhage: a single-center experience

et al. 2021

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Platelet activation has been postulated to be involved in the pathogenesis of delayed cerebral ischemia (DCI) and cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to investigate potentially beneficial effects of antiplatelet therapy (APT) on angiographic CVS, DCI-related infarction and functional outcome in endovascularly treated aSAH patients. Retrospective single-center analysis of aSAH patients treated by endovascular aneurysm obliteration. Based on the post-interventional medical regime, patients were assigned to either an APT group or a control group not receiving APT. A subgroup analysis separately investigated those APT patients with aspirin monotherapy (MAPT) and those receiving dual treatment (aspirin plus clopidogrel, DAPT). Clinical and radiological characteristics were compared between groups. Possible predictors for angiographic CVS, DCI-related infarction, and an unfavorable functional outcome (modified Rankin scale ≥ 3) were analyzed. Of 160 patients, 85 (53%) had received APT (n = 29 MAPT, n = 56 DAPT). APT was independently associated with a lower incidence of an unfavorable functional outcome (OR 0.40 [0.19–0.87], P = 0.021) after 3 months. APT did not reduce the incidence of angiographic CVS or DCI-related infarction. The pattern of angiographic CVS or DCI-related infarction as well as the rate of intracranial hemorrhage did not differ between groups. However, the lesion volume of DCI-related infarctions was significantly reduced in the DAPT subgroup (P = 0.011). Post-interventional APT in endovascularly treated aSAH patients is associated with better functional outcome at 3 months. The beneficial effect of APT might be mediated by reduction of the size of DCI-related infarctions.

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Section: Discussionmentioning

confidence: 99%

Effects of post-interventional antiplatelet therapy on angiographic vasospasm, delayed cerebral ischemia, and clinical outcome after aneurysmal subarachnoid hemorrhage: a single-center experience

et al. 2021

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“…A Korean study found that prolonged partial thromboplastin time was major risk factor of DICH 11 . Some studies showed that dual antiplatelet therapy and postoperative anticoagulation therapy would increase the risk of DICH 10 , 23 . As for our study, we excluded the patients with anticoagulant or antiplatelet therapy in order to control the confounding factors, and we found that preoperative PT, APTT, INR and PLT were not risk factors for DICH.…”

Section: Discussionmentioning

confidence: 99%

A new inflammatory parameter can predict delayed intracranial hemorrhage following ventriculoperitoneal shunt

Wang

et al. 2021

Sci Rep

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Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event. This study aimed to investigate the association between a ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio (NLRR) and DICH secondary to VP shunt. We performed a retrospective review of patients who underwent VP shunt between January 2016 and June 2020. Multivariable logistic regression analysis was used to assess the association of DICH and NLRR. Then patients were divided into two groups according to the optimal cut-off point of NLRR, propensity score matching (PSM) method was performed to reconfirm the result. A total of 130 patients were enrolled and DICH occurred in 29 patients. Elevated NLRR and history of craniotomy were independent risk factors for DICH secondary to VP shunt. The optimal cut off point of NLRR was 2.05, and the sensitivity was 89.7%, the specificity was 63.4%. Patients with NLRR > 2.05 had much higher incidence of DICH (40.6% vs 4.5%). Our finding suggested that DICH following VP shunt was not a rare complication and elevated NLRR could independently predict DICH. Inflammatory responses might play an important role in the development of DICH following VP shunt.

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“…A Korean study found that prolonged partial thromboplastin time was major risk factor of DICH 18 . Some studies showed that dual antiplatelet therapy and postoperative anticoagulation therapy would increase the risk of DICH 17,23 . As for our study, we excluded the patients with anticoagulant or antiplatelet therapy in order to control the confounding factors, and we found that preoperative PT, APTT, INR and PLT were not risk factors for DICH.…”

Section: Discussionmentioning

confidence: 99%

A New Inflammatory Parameter Can Predict Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt

Wang²,

et al. 2020

Preprint

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Background: Delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is considered to be a potentially severe event, however, little is known about the risk factors and underlying mechanisms. This study aimed to investigate the association between NLRR (a ratio of postoperative neutrophil-to-lymphocyte ratio to preoperative neutrophil-to-lymphocyte ratio) and DICH secondary to VP shunt.Methods: We performed a retrospective review of patients who underwent VP shunt between January 2016 and June 2020. Multivariable logistic regression analysis was used to assess the association of DICH and NLRR. Then patients were divided into two groups according to the optimal cut-off point of NLRR, propensity score matching (PSM) method was performed to reconfirm the result.Results: A total of 130 patients were enrolled and DICH occurred in 29 patients. Elevated NLRR (odds ratio [OR], 2.774; 95% confidence interval [CI], 1.372-5.609; P<0.001) and history of craniotomy (OR, 3.505; 95%CI, 1.040-11.813; p=0.043) were independent risk factors for DICH secondary to VP shunt. Receiver operating characteristic curve analysis of NLRR showed that area under the curve was 0.832. The optimal cut off point of NLRR was 2.05, and the sensitivity was 89.7%, the specificity was 63.4%. Patients with NLRR>2.05 had much higher incidence of DICH (OR, 11.25; 95%CI, 1.35-93.50; p=0.025; PSM cohort, n=82). Conclusions: Our finding suggested that DICH following VP shunt was not a rare complication and elevated NLRR could independently predict DICH. Inflammatory responses might play an important role in the development of DICH following VP shunt.

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Hemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis

Cited by 40 publications

References 18 publications

Effects of post-interventional antiplatelet therapy on angiographic vasospasm, delayed cerebral ischemia, and clinical outcome after aneurysmal subarachnoid hemorrhage: a single-center experience

Effects of post-interventional antiplatelet therapy on angiographic vasospasm, delayed cerebral ischemia, and clinical outcome after aneurysmal subarachnoid hemorrhage: a single-center experience

A new inflammatory parameter can predict delayed intracranial hemorrhage following ventriculoperitoneal shunt

A New Inflammatory Parameter Can Predict Delayed Intracranial Hemorrhage Following Ventriculoperitoneal Shunt

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