title: Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms.
abstract: OBJECTIVE
  Stent-assisted coiling of intracranial aneurysms requires antiplatelet therapy, typically aspirin and clopidogrel to prevent thromboembolic complications. There is a substantial concern that tirofiban may increase the risk of hemorrhage when used as an antiplatelet premedication in ruptured intracranial aneurysms. Our aim was to evaluate the safety and efficacy of intravenous tirofiban administration, instead of oral dual antiplatelet agents, as an antiplatelet premedication for stent-assisted coiling in patients with acutely ruptured intracranial aneurysms.
  
  
  METHODS
  We conducted a retrospective review of a data base containing a consecutive series of patients who underwent stent-assisted coiling for acutely ruptured intracranial aneurysms between March 2010 and January 2015. Intravenous tirofiban was administered to all patients before stent-assisted coiling, instead of premedication with loading doses of aspirin or clopidogrel.
  
  
  RESULTS
  Forty patients with 41 aneurysms received intravenous tirofiban and underwent stent-assisted coiling. None of the patients had a newly developed intracerebral hemorrhage, subarachnoid hemorrhage, or intraventricular hemorrhage. Intraprocedural aneurysmal rupture occurred in 2 patients (5%). Cerebral infarction developed in 2 patients (5%). Ventriculostomy-related hemorrhage was seen in 2 of 10 patients in whom ventriculostomy was performed before or after coiling. Thirty-four (85%) patients had a good outcome (Glasgow Outcome Score of 4 or 5) at the time of discharge, but 1 patient died of cardiac arrest. None of the patients developed thrombocytopenia, retroperitoneal, gastrointestinal, or genitourinary bleeding related to tirofiban administration.
  
  
  CONCLUSIONS
  In our study, tirofiban showed a low risk of symptomatic hemorrhagic or thromboembolic complications. Tirofiban may offer a safe and effective alternative as an antiplatelet premedication during stent-assisted coiling of acutely ruptured intracranial aneurysms.
authors.affiliation: From the Departments of Radiology (S.K., M.K.).
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-0731-3806
authors.initials: S
authors.lastname: Kim
authors.affiliation: Neurosurgery (J.-H.C., J.-T.H.).
authors.forename: J-H
authors.identifier: http://orcid.org/0000-0001-7250-9197
authors.initials: JH
authors.lastname: Choi
authors.affiliation: From the Departments of Radiology (S.K., M.K.) myongjin.kang@gmail.com.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-6927-3491
authors.initials: M
authors.lastname: Kang
authors.affiliation: Neurology (J.-K.C.), Busan-Ulsan Regional Cardio-Cerebrovascular Disease Center, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: J-K
authors.identifier: http://orcid.org/0000-0001-8704-3318
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Neurosurgery (J.-H.C., J.-T.H.).
authors.forename: J-T
authors.identifier: http://orcid.org/0000-0003-3937-2664
authors.initials: JT
authors.lastname: Huh
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D017542:Aneurysm, Ruptured / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000517:prevention & control; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011292:Premedication; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban