Delayed intracranial hemorrhage associated with antiplatelet therapy in stent-assisted coil embolized cerebral aneurysms.
Administration of oral clopidogrel plus aspirin is the most important regimen to reduce thromboembolic complications in stent-assisted coil embolization of cerebral aneurysm. However, such therapy may increase the risk of hemorrhage. The purpose of this study is to analyze the effect of two different antiplatelet regimens on hemorrhagic and thromboembolic complication rates around the stent-assisted coil embolization period. Records over a 2-year period were reviewed in a retrospective cohort study. For 49 consecutive stent-assisted coil embolization procedures over 41 patients, nine patients received routine antiplatelet drugs (300 mg aspirin and 75 mg clopidogrel) for 3 days before embolization, and 32 received a loading dose of antiplatelet drugs (300 mg aspirin and 300 mg clopidogrel) just before induction of anesthesia. Delayed intracerebral hemorrhage (DIH) was observed more often in the routine antiplatelet group (2/9 cases, 22.2%) in comparison with the loading group (0/32 cases, 0%; P = 0.044; Fisher exact test). The two hemorrhagic cases were both female, and occurred within 24 h of postembolization. The thromboembolic complication rates were not significantly different between the two groups. Oral administration of routine antiplatelet drugs for 3 days before stent-assisted coil embolization possibly increases the risk of delayed intracranial hemorrhage, compared to loading group. Symptomatic thromboembolic complications have no significant difference in the two different regimens.
Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R., China.
Xiao-Dong
XD
Zhang
Hai-Tao
HT
Wu
Ji
J
Zhu
Zhao-Hui
ZH
He
Wei-Na
WN
Chai
Xiao-Chuan
XC
Sun
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000077144:Clopidogrel; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D002532:Intracranial Aneurysm / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D015898:Tomography Scanners, X-Ray Computed
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin