Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms.

Journal Article (Journal Article)

BACKGROUND: Endovascular 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. METHODS: We 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. RESULTS: One-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. CONCLUSION: The 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.

Full Text

Duke Authors

Cited Authors

  • Samaniego, EA; Gibson, E; Nakagawa, D; Ortega-Gutierrez, S; Zanaty, M; Roa, JA; Jabbour, P; Hasan, DM

Published Date

  • March 2019

Published In

Volume / Issue

  • 4 / 1

Start / End Page

  • 36 - 42

PubMed ID

  • 31105977

Pubmed Central ID

  • PMC6475079

Electronic International Standard Serial Number (EISSN)

  • 2059-8696

Digital Object Identifier (DOI)

  • 10.1136/svn-2018-000192

Language

  • eng

Conference Location

  • England