title: Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms.
abstract: BACKGROUND
  Coil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.
  
  
  OBJECTIVE
  To determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.
  
  
  METHODS
  Tirofiban was administered as an intravenous bolus (8.0 μg/kg over 3 min) followed by a maintenance infusion (0.10 μg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2 h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.
  
  
  RESULTS
  Tirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found.
  
  
  CONCLUSIONS
  Tirofiban bolus over 3 min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.
authors.affiliation: Department of Interventional Therapy Center, Stroke Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Liang
authors.affiliation: Department of Interventional Therapy Center, Stroke Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
authors.forename: Zi-Liang
authors.initials: ZL
authors.lastname: Wang
authors.affiliation: Department of Interventional Therapy Center, Stroke Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
authors.forename: Tian-Xiao
authors.initials: TX
authors.lastname: Li
authors.affiliation: Department of Interventional Therapy Center, Stroke Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
authors.forename: Ying-Kun
authors.initials: YK
authors.lastname: He
authors.affiliation: Department of Interventional Therapy Center, Stroke Center, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
authors.forename: Wei-Xing
authors.initials: WX
authors.lastname: Bai
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Yang-Yang
authors.initials: YY
authors.lastname: Wang
authors.affiliation: School of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Guo-Yu
authors.initials: GY
authors.lastname: Zhou
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D015607:Stents; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban
keywords: Aneurysm; Hemorrhage