Intravenous administration of tirofiban versus loading dose of oral clopidogrel for preventing thromboembolism in stent-assisted coiling of intracranial aneurysms

Abstract

Background Thromboembolic complications after stenting of intracranial aneurysms may be affected by antiplatelet administration. Aims This retrospective study aimed to assess the safety of intravenous tirofiban versus loading dose of oral clopidogrel for preventing thromboembolism in stent-assisted coiling of intracranial aneurysms. Methods From January 2006 to December 2013, 281 patients with cerebral aneurysms were treated with stent-coiling using two antiplatelet strategies in comparison: the initial strategy (a loading dose of ≥300 mg clopidogrel followed by dual antiplatelet, clopidogrel group) and the modified strategy (intravenous administration of tirofiban 8 µg/kg over 3 min followed by a maintenance dose of 0.1 µg/kg/min for 24 h, tirofiban group). The end points were rates of perioperative thromboembolic events and intracranial hemorrhages. Results Thromboembolic events were observed more often in the clopidogrel group (13/120 aneurysms, 10.83%) than the tirofiban group (6/178 aneurysms, 3.37%; P = 0.010), with no increase in the rate of intracranial hemorrhages ( P = 0.164). In the ruptured subgroups, thromboembolic events were significantly fewer in the tirofiban subgroup (5/128, 3.91%) compared with the clopidogrel subgroup (7/53, 13.21%; P = 0.043) with no increase in the rate of hemorrhage ( P = 0.360). Conclusions Intravenous administration of tirofiban is safe in intracranial aneurysms treated with stent-assisted coiling.

Endovascular Treatment of Ruptured Middle Cerebral Artery Bifurcation Aneurysms. A Retrospective Observational Study of Short- and Long-Term Follow-Up

“…In addition to hemorrhagic events and intraprocedural ruptures, three thromboembolic events occurred while intervening without specific distribution, but were immediately treated with intravenous GP-IIb/IIIa-Inhibitors. This low number might be a result of the prophylactic intravenous dose of Tirofiban, which we favored over Clopidogrel [14,15]. Other complications were mainly postprocedural and had a disease-related etiology.…”

Glycoprotein IIb/IIIa inhibitors for the neurointerventionalist

“…Specifically for stent-assisted coiling, prophylactic administration of tirofiban via the intravenous route resulted in fewer thromboembolic events (3.37–3.91%) compared to the clopidogrel group (10.83–13.21%), without an increase in risk of intracranial hemorrhage. 31 However, according to a study by Chalouhi et al., the standard intravenous protocol (bolus + infusion) resulted in a higher rate of intracranial hemorrhage compared to the infusion (without a bolus) approach, 30 highlighting the need for further prospective studies to clarify these risks.…”

Acute stent thrombosis after stent-assisted coiling in an intracranial aneurysm patient carrying two reduced-function CYP2C19 alleles

“…[ 1 ] To date, dual antiplatelet treatment, comprising aspirin plus clopidogrel, is advocated in patients with high thrombotic risk. [ 2 ] Whereas, patients are potentially at risk of further thromboembolic events after SAC in spite of positive antiplatelet treatment, and stent thrombosis (ST) is one of the most serious complications in IA patients post SAC. [ 2 ]…”

“…[ 2 ] Whereas, patients are potentially at risk of further thromboembolic events after SAC in spite of positive antiplatelet treatment, and stent thrombosis (ST) is one of the most serious complications in IA patients post SAC. [ 2 ]…”

“…Clopidogrel, an irreversible inhibitor of the platelet adenosine diphosphate (ADP) P2Y12 receptor, is the standard antiplatelet agent following SAC in order to reduce recurrent thrombotic events. [ 2 ] However, about 4% to 30% of the patients treated with clopidogrel display no or a low antiplatelet response, which increased the risk of recurrent ischemic events. [ 3 ] One source of the variability may be the metabolism of clopidogrel.…”