Increased risk of Ventriculostomy-Associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms

Qin, Guowen; Pang, Gang; Zhong, Shaomin; Chen, Haijun; Tang, Xihe; Lan, Shengyong

doi:10.1080/02688697.2020.1787338

Cited by 10 publications

(12 citation statements)

References 26 publications

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“…In this series, VS-ICH occurred in 13.1% of all cases, which is in line with other studies reporting rates from 10 to 20% [3,10]. While the observed predominance of ICH in the endovascular group con rms previously reported data from Scheller et al, this difference was no longer present among patients receiving no antiplatelet therapy [21]. Accordingly, the major nding of this study is that the administration of any antiplatelet therapy was the most prominent risk factor for VS-ICH.…”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Ventriculostomy-Related Intracranial Hemorrhage Following Surgical and Endovascular Treatment of Ruptured Aneurysms

Lenschow

Spreckelsen

Telentschak

et al. 2022

Preprint

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Introduction : Endovascular therapy of ruptured aneurysms is regularly accompanied by periprocedural heparinization and requires the use of periprocedural antiplatelets in more complex cases. This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. Materials and Methods In this retrospective analysis we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. Results A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (p=0.011), but not in cases without antiplatelet therapy (p=0.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141-6.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859-3.395]) were independent predictors of ventriculostomy-related hemorrhages. Discussion Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision making, it must be weighed against the benefits of endovascular techniques.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Ventriculostomy-Related Intracranial Hemorrhage Following Surgical and Endovascular Treatment of Ruptured Aneurysms

Lenschow

Spreckelsen

Telentschak

et al. 2022

Preprint

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“…In this regard, the primary objective of our study was to assess the risk of VS-ICH between endovascular and surgical treatment, as this is frequently debated in our clinical practice. While previous reports found no effect of VS-ICH on clinical outcome [ 3 , 8 , 15 , 20 ], we chose not to analyze clinical outcome in our study because we do not believe that, in the context of a retrospective study, a meaningful correlation can be drawn between these largely minor hemorrhages and the overall clinical outcome in patients often severely affected by the subarachnoid hemorrhage. Regarding acute hemorrhage-related changes in clinical status, clinical evaluation was limited since most patients were sedated at the time of VS-ICH; however, no new oculomotor dysfunction was observed in any of the patients with VS-ICH in our study cohort.…”

Section: Discussionmentioning

confidence: 99%

Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms

et al. 2022

View full text Add to dashboard Cite

Endovascular therapy of ruptured aneurysms is regularly accompanied by periprocedural heparinization and requires the use of periprocedural antiplatelets in more complex cases. This raises concerns regarding increased bleeding risks in the case of frequently required ventriculostomy. The aim of this study was to analyze risk factors for ventriculostomy-related intracranial hemorrhages (VS-ICH) in endovascular or surgical treatment of ruptured aneurysms with a focus on antithrombotic therapy. In this retrospective analysis, we included patients admitted to our institution over a 12-year period who had received at least one ventriculostomy due to subarachnoid hemorrhage-related hydrocephalus. Patients were dichotomized into an endovascular and surgical group and rates of VS-ICH were compared. Risk factors for VS-ICH were assessed in uni- and multivariate analyses. A total of 606 ventriculostomies were performed in 328 patients. Within the endovascular group, antiplatelet therapy was used in 44.8% of cases. The overall rate of ventriculostomy-related intracranial hemorrhage was 13.1%. Endovascular treatment was associated with a higher rate of VS-ICH compared to surgical treatment (p = 0.011), but not in cases without antiplatelet therapy (p = 0.166). Application of any antiplatelet therapy (odds ratio, 2.647 [95% confidence interval, 1.141–6.143]) and number of ventriculostomies (odds ratio, 2.513 [95% confidence interval, 1.859–3.395]) were independent predictors of ventriculostomy-related hemorrhages. Our findings indicate an increased risk of VS-ICH in the endovascular group if administration of antiplatelets was required. While this aspect has to be included into treatment decision-making, it must be weighed against the benefits of endovascular techniques.

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“…1,2 However, it is well established that antiplatelet agents will increase the risk of ventriculostomy associated bleeding. 9,14,15 A combination of aspirin and clopidogrel has been shown to have a more significant impact in prior studies but single-agent therapy with aspirin has been deemed low risk for symptomatic bleeding. 9 The aim of this observational study was to determine specifically whether, in the context of acute subarachnoid hemorrhage, administration of intravenous aspirin during endovascular treatment of ruptured intracranial aneurysms within 48 hours of the ventriculostomy procedure significantly increases the risk of ventriculostomy-associated hemorrhage and whether this bleeding alters clinical outcome (only a tiny minority of patients in this study received an additional agent, whereas many other studies included patients with dual anti-platelets in this context).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have found VAH rates to be significantly higher when ventriculostomy is performed following aspirin administration 9 while others have shown a non-significant trend towards increased VAH if ventriculostomy is performed following aspirin administration. 15,16 For those patients drained after administration of antiplatelet agents, platelet infusions are commonly used though this may not alter the rate of associated hemorrhage. 17 The potential benefits of aspirin at slightly more delayed time points following ventriculostomy and aneurysm securing procedures, particularly during the period most associated with delayed cerebral ischemia (DCI), 4 likely warrant further investigation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intravenous Aspirin Administration on Ventriculostomy-Associated Hemorrhage in Coiled Acute Subarachnoid Hemorrhage Patients

et al. 2021

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Purpose: Aspirin has beneficial effects on coiling, even in acute subarachnoid hemorrhage, but there is also a perceived risk of increased bleeding and, importantly, a concern regarding ventriculostomy-associated hemorrhage (VAH) in those with complicating hydrocephalus. We aimed to assess the rate and extent of VAH in patients specifically treated with procedural intravenous aspirin during endovascular coiling of ruptured intracranial aneurysms.Materials and Methods: This was a single neurovascular center retrospective observational study of consecutive patients treated over a three-year period. The rate of VAH assessed using computed tomography and clinical outcomes were compared in patients receiving intraprocedural intravenous aspirin loading (n=90) versus those that did not receive the drug (n=40).Results: There was a significantly elevated rate of VAH in patients receiving intravenous aspirin (30% vs. 2.5%, odds ratio 16.7 [95% confidence interval: 2.2–128.0], P<0.0001). The majority of VAH was <10 mm in size (70%) with the largest bleed measuring 20 mm. No hematoma required surgical evacuation. No difference in favorable outcome at discharge was demonstrated. There was no difference in mortality between the 2 groups.Conclusion: Loading with intravenous aspirin during endovascular treatment of ruptured intracranial aneurysms significantly increases the risk of VAH, but most are small with minimal impact on clinical outcome at discharge. Intravenous aspirin should probably be reserved for selected cases but should not be withheld based on risk of VAH.

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Increased risk of Ventriculostomy-Associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms

Cited by 10 publications

References 26 publications

Ventriculostomy-Related Intracranial Hemorrhage Following Surgical and Endovascular Treatment of Ruptured Aneurysms

Ventriculostomy-Related Intracranial Hemorrhage Following Surgical and Endovascular Treatment of Ruptured Aneurysms

Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms

Impact of Intravenous Aspirin Administration on Ventriculostomy-Associated Hemorrhage in Coiled Acute Subarachnoid Hemorrhage Patients

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