Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms?
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.
Kang
Hyun-Seung
HS
Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
Han
Moon Hee
MH
Kwon
Bae Ju
BJ
Jung
Cheolkyu
C
Kim
Jeong-Eun
JE
Kwon
O-Ki
OK
Oh
Chang Wan
CW
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*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine