Thromboelastography detects inadequate response to abciximab therapy during stent-assisted cerebral aneurysm coil embolization complicated by stroke.

Journal Article (Journal Article)

INTRODUCTION: Thromboembolic stroke is the most common severe complication following coil embolization of intracerebral aneurysms, with a 5% incidence of permanent deficits. Despite heparin anticoagulation, rescue therapy with the platelet glycoprotein IIb/IIIa receptor antagonist abciximab may be required. However, we describe a failure of abciximab rescue therapy and discuss the importance of monitoring the variable individual response to abciximab. CASE REPORTS: Two patients underwent stent-assisted cerebral aneurysm coil embolization complicated by thromboembolic stroke. In one patient, abciximab rescue therapy failed and was associated with a poor neurological outcome. Thromboelastography (TEG model 5000; Haemoscope, Skokie, IL) and platelet aggregometry suggested inadequate platelet inhibition, although other tests of platelet function suggested adequate inhibition. CONCLUSION: We describe a failure of regular-dose abciximab rescue therapy for thromboembolic stroke-complicating stent-assisted cerebral aneurysm coil embolization. The use of TEG to individualize abciximab dosing in this setting may improve patient outcome, as it tracks a pattern of coagulation consistent with the clinical picture.

Full Text

Duke Authors

Cited Authors

  • Lombard, FW; Welsby, IJ; Alexander, MJ; Borel, CO

Published Date

  • 2006

Published In

Volume / Issue

  • 4 / 1

Start / End Page

  • 32 - 34

PubMed ID

  • 16498193

International Standard Serial Number (ISSN)

  • 1541-6933

Digital Object Identifier (DOI)

  • 10.1385/NCC:4:1:032


  • eng

Conference Location

  • United States