Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

Abstract

BackgroundEndovascular treatment of intracranial aneurysms usually involves stent-assisted coiling (SAC) and flow diverters. Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy (DAPT) are required to prevent thromboembolic complications afterwards. We sought to determine the safety of tirofiban and DAPT in these cases.MethodsWe conducted a retrospective analysis of our database for patients with intracranial aneurysms who underwent SAC or flow diversion. The tirofiban-DAPT protocol used is described. Data regarding duration of infusion, placement of external ventricular devices (EVDs), complications, haemoglobin levels and platelet count before and 24 hours after antiplatelet therapy were collected and analysed.ResultsOne-hundred and forty-one patients with 148 aneurysms/procedures were included. 110 aneurysms were treated acutely and 38 electively. Minor and major haemorrhagic events were recognised in 20% (30/148) aneurysms. Only 5 (3.4%) intracerebral haemorrhages were symptomatic: 3 cortical/SAH and 2 EVD-related. The average blood volume in symptomatic haemorrhages was 24.8 cc versus 5.42 cc in asymptomatic haemorrhages (p=0.002). The rate of EVD-related haemorrhages was 15.7% (19/121) and only 2 (1.7%) were symptomatic. Most haemorrhagic events occurred in ruptured aneurysms (90.1%, p=0.01). No significant change in platelet count or haemoglobin levels before and 24 hours after administration of tirofiban and DAPT was documented. Concomitant administration of heparin did not increase haemorrhagic events.ConclusionThe use of the GP IIb/IIIa inhibitors tirofiban and DAPT in this series was safe. Tirofiban and DAPT did not affect platelet count or haemoglobin levels and did not increase rate of symptomatic haemorrhages or thromboembolic complications.

Development and Clinical Translation of a Perioperative Nomogram Incorporating Free Fatty Acids to Predict Poor Outcome of Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment

“…Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating stroke with high mortality and morbidity rate (1). As two large clinical trials showed that endovascular coiling could lead to longer disability-free survival and fewer worse outcome compared with neurosurgical clipping in treating ruptured intracranial aneurysms (2,3), endovascular management of aSAH has been the first-line therapy in many clinical centers (4); however, despite its advantage over surgical clipping, endovascular coiling therapy still has an inherent risk of poor clinical outcomes due to the sudden onset of severe complications (5,6). To reduce complications and improve aSAH recovery, clinical variables, such as premorbid history, radiological examination, and laboratory tests, collected at the first admission to medical centers were widely reported to be able to predict outcome following endovascular treatment, guiding the neuro interventionalists to provide essential medical supports to inpatients (7,8).…”

Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

“…Consensus recommendations for the dosage of GPIIb/IIIa receptor inhibitors[18][19][20][21][22][23][24][25][26] …”

Characterization of antiplatelet response to low‐dose cangrelor utilizing platelet function testing in neuroendovascular patients

“…Furthermore, GP IIb/IIIa inhibitors are highly potent antiplatelet inhibitors and have significant platelet dissolution effects, 26 which may be advantageous during acute ischemic stroke treatment, but a theoretical concern exists for use during aneurysm repair as clot dissolution may cause re‐bleeding. Currently, the literature is evolving to support the use of tirofiban during aneurysm repair with promising outcomes 27–29 . Recently, cangrelor was directly compared to tirofiban in PCI and tirofiban was shown to be superior in terms of antiplatelet activity, but these results remain controversial 30,31 .…”