title: Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms?
abstract: BACKGROUND
  Thromboembolism is a common complication related to coil embolization of intracranial aneurysms.
  
  
  OBJECTIVE
  To identify factors related to thromboembolic events during coil embolization for unruptured intracranial aneurysms and to evaluate the role of clopidogrel premedication to prevent thromboembolisms.
  
  
  METHODS
  Since March 2006, clopidogrel has been administered to patients with unruptured aneurysms before coil embolization (the clopidogrel group) in our institution. The clopidogrel group (416 patients with 485 aneurysms) and the historical control group (140 patients with 159 aneurysms who received no antiplatelet premedication) were compared to find the efficacy of clopidogrel premedication. Various factors, including age, sex, body weight, and medical history of hypertension, diabetes mellitus, hyperlipidemia, smoking, previous stroke, and heart disease, as well as clopidogrel premedication, were analyzed in relationship to the development of a procedure-related thromboembolism.
  
  
  RESULTS
  Procedure-related thromboembolic events tended to occur less frequently in the clopidogrel group compared with the control group (7.4% vs 12.6%; P = .05), and clopidogrel premedication could modify the risk in female patients from 11.1% to 5.2% (P = .04). The use of multiple logistic regression analysis identified clopidogrel premedication (P = .03), smoking (P = .002), and hyperlipidemia (P = .02) as significant factors related to the formation of thromboembolism.
  
  
  CONCLUSIONS
  Clopidogrel premedication seems to have a beneficial effect in reducing the number of procedure-related thromboembolisms during coil embolization for unruptured intracranial aneurysms, especially in female patients. Smoking and hyperlipidemia were independent risk factors related to thromboembolism.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.forename: Bae Ju
authors.initials: BJ
authors.lastname: Kwon
authors.forename: Cheolkyu
authors.initials: C
authors.lastname: Jung
authors.forename: Jeong-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
mesh_terms: D017542:Aneurysm, Ruptured / Q000453:epidemiology / Q000517:prevention & control; D000077144:Clopidogrel; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011292:Premedication / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine