Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms

2015 ◽  
Vol 8 (11) ◽  
pp. 1148-1153 ◽  
Author(s):  
Xiao-dong Liang ◽  
Zi-liang Wang ◽  
Tian-xiao Li ◽  
Ying-kun He ◽  
Wei-xing Bai ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Thromboembolic Events ◽  
Maintenance Infusion ◽  
Safety And Efficacy ◽  
Fatal Hemorrhage ◽  
Ruptured Intracranial Aneurysms

BackgroundCoil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.ObjectiveTo determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.MethodsTirofiban 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.ResultsTirofiban 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.ConclusionsTirofiban 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.

Safety and Efficacy of Tirofiban in Stent-Assisted Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 710-714 ◽  
Author(s):  
Nohra Chalouhi ◽  
Pascal Jabbour ◽  
David Kung ◽  
David Hasan
Keyword(s):  
Intracranial Aneurysms ◽  
Thromboembolic Events ◽  
Intracranial Hemorrhages ◽  
Maintenance Infusion ◽  
Safety And Efficacy ◽  
Computed Tomographic ◽  
Rescue Treatment ◽  
Arterial Recanalization ◽  
Risk Of Hemorrhage ◽  
Initial Bolus

Abstract BACKGROUND: Thromboembolic complications are a major concern in stent-assisted coiling of intracranial aneurysms that may be prevented with adequate antiplatelet therapy. OBJECTIVE: To assess the safety and efficacy of tirofiban in stent-assisted coiling. METHODS: Two protocols were used. In the initial protocol, tirofiban was administered intravenously as a 0.4 μg/kg per min bolus for 30 minutes followed by 0.10 μg.kg−1 min−1 maintenance infusion. The revised protocol consisted of a 0.10 μg.kg−1 min−1 maintenance infusion alone. RESULTS: Sixty-seven patients received tirofiban, 16 under the initial protocol and 51 under the revised protocol. Thirty (44.8%) patients had sustained a subarachnoid hemorrhage (SAH). Tirofiban infusion was initiated after thromboembolic events in 9 (13.4%) patients and prophylactically in 58 (86.6%). Four (6.0%) intracranial hemorrhages were noted. Three (18.8%) intracranial hemorrhages occurred with the initial protocol in patients treated electively and were fatal in 2 (66.7%) cases. The only complication (1.9%) under the revised protocol was a subclinical worsening of the computed tomographic appearance of an SAH. There was no tirofiban-related morbidity or deaths with the revised protocol. Of 9 patients that received tirofiban as a rescue treatment, 7 (77.8%) had complete and 2 (22.2%) had partial arterial recanalization. No thromboembolic events occurred in patients receiving prophylactic tirofiban. CONCLUSION: A bolus followed by a maintenance dose of tirofiban appears to have a high risk of cerebral hemorrhage. A maintenance infusion without an initial bolus, however, has an exceedingly low risk of hemorrhage and appears to be very safe and effective, even in the setting of SAH.

Prophylactic administration of tirofiban for preventing thromboembolic events in flow diversion treatment of intracranial aneurysms

2020 ◽  
pp. neurintsurg-2020-016878
Author(s):  
Qiaowei Wu ◽  
Qiuji Shao ◽  
Li Li ◽  
Xiaodong Liang ◽  
Kaitao Chang ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Flow Diverter ◽  
Thromboembolic Events ◽  
Maintenance Infusion ◽  
Prophylactic Administration ◽  
Unruptured Intracranial Aneurysms ◽  
Hemorrhagic Events ◽  
Prophylactic Use

BackgroundFlow diverter (FD) is widely used in the treatment of intracranial aneurysms. However, thromboembolic events (TEs) continue to be the major complications during the periprocedural phase. To evaluate the safety and efficacy of the prophylactic use of tirofiban, combined with the conventional dual antiplatelet therapy (DAT), as a new antiplatelet protocol in patients with intracranial aneurysms treated with FDs.MethodsAt least 3–5 days before the procedure, daily DAT were administrated to the patients. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period during or immediately after FD deployment, followed by a 0.05 µg/kg/min maintenance infusion for 24–48 hours. Periprocedural TEs and hemorrhagic events (HEs) were recorded.ResultsA total of 331 patients were included, including 229 (69.2%) who received tirofiban administration (tirofiban group) and 102 (30.8%) who received only DAT (non-tirofiban group). Periprocedural TEs occurred in 12 (3.6%) patients, including eight (7.8%) in the non-tirofiban group and four (1.7%) in the tirofiban group. In multivariate analysis, patients receiving tirofiban administration had significantly lower TEs as compared with those who received only DAT (P=0.004). Balloon angioplasty and longer procedure time (>137 min) were also risk factors for TEs. Also, no increase was observed in the rate of HEs related to tirofiban administration.ConclusionsThe current study suggested that prophylactic administration of tirofiban combined with conventional oral DAT seems safe and efficient for preventing TEs during FD treatment of unruptured intracranial aneurysms. Balloon angioplasty and prolonged procedure are associated with a high risk of TEs.

Safety and efficacy of intravenous tirofiban for stent-assisted coiling in acutely ruptured intracranial aneurysms: A single center experience

2021 ◽  
pp. 159101992110424
Author(s):  
Yihui Ma ◽  
Chenguang Jia ◽  
Tingbao Zhang ◽  
Yu Feng ◽  
Xinjun Chen ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Clinical Severity ◽  
Optimal Dosage ◽  
Thromboembolic Complications ◽  
Stent Deployment ◽  
Safety And Efficacy ◽  
Single Center Experience ◽  
Grade Ii ◽  
Ruptured Intracranial Aneurysms

Background There have been few reports on the use of tirofiban in ruptured intracranial aneurysms and the results were conflicting. However, the safety and efficacy of optimal dosage and the reasonable treatment course of tirofiban have not been determined. Objective To determine the safety and efficacy of a new protocol for its prophylactic tirofiban application during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications. Methods This retrospective study was based on 105 patients with ruptured aneurysms who underwent stent-assisted coiling at our institution between August 2017 and July 2020. Intravenous tirofiban was administered to patients after stent deployment. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period immediately after stent deployment, followed by a 0.06–0.08 µg/kg/min maintenance infusion for 12–24 h. Dual oral antiplatelet therapy was overlapped with half the tirofiban dose 2 h before the cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded. Results This study included a total of 105 patients with ruptured intracranial aneurysms, who underwent stent-assisted coiling. In terms of clinical severity, a presenting Hunt–Hess clinical-grade I was observed in 47 (44.8%) cases, grade II in 19 (18.1%) cases, grade III in 30 (28.6%) cases, grade IV in 6 (5.6%) cases, and grade V in 3 (2.9%) cases. None of the patients showed a newly developed tirofiban-related intracerebral hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, or ventriculostomy-related hemorrhage. There were 3 (2.8%) patients who had thromboembolic complications. Conclusions We have determined a new protocol for prophylactic intraoperative tirofiban during the endovascular treatment of ruptured intracranial aneurysms with no oral antiplatelet medications. In our study, tirofiban showed a low risk of hemorrhagic or thromboembolic complications. Tirofiban appears to be a safe and alternative during the stent-assisted coiling of ruptured intracranial aneurysms.

Abstract TP427: National Estimates of Recurrent Intracranial Hemorrhage Among Patients with Ruptured Intracranial Aneurysms: Effect of Treatment Modality

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Mohammad R Afzal ◽  
Burhan Chaudhry ◽  
Haseeb Rehman ◽  
Ahmed Riaz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Confidence Interval ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Ruptured Intracranial Aneurysm ◽  
Hospitalization Period ◽  
Ruptured Intracranial Aneurysms

Background: The estimates of recurrent intracranial hemorrhage in post hospitalization period among patients treated for ruptured intracranial aneurysms are not available outside clinical trials. Objective: To determine the rates of recurrent intracranial hemorrhage related hospitalization within 1 year post hospitalization for treatment of ruptured intracranial aneurysm in a nationwide cohort of patients admitted for subarachnoid hemorrhage (SAH). Methods: We identified all readmissions related to new SAH or intracerebral hemorrhage in the nationally representative data for all patients hospitalized for SAH using the Nationwide Readmissions Database (NRD) 2013 who had undergone endovascular or surgical treatment.. Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent intracranial hemorrhage for patients in treatment cohorts after adjusting for potential confounders. The 1-year survival was estimated for both treatment groups by using Kaplan-Meier survival method. Results: A total of 5,844 patients with SAH were treated with either endovascular (n = 2,843, 48.6%) or surgical treatment (n = 3000, 51.4%).The rate of all-cause in-hospital mortality (10.2% vs 12.1%, P = 0.1895) was similar among patients treated with surgical or endovascular treatment. The estimated 1-year recurrent intracranial hemorrhage survival was 99.5% and 97.4% in patients who underwent surgical and endovascular treatments, respectively (p= <.0001). After adjusting for age, and All Patient Refined DRGs (APDRG) severity score, the RRs of recurrent any intracranial hemorrhage was higher with endovascular treatment (RR, 6.0; 95% confidence interval (CI), 2.3 -15.7 p= 0.0002). The rates of SAH (RR, 6.1; 95% CI, 2.1 -17.9 p= <.0001) was significantly higher and a trend was observed for higher rate ofintracerebral hemorrhage (RR, 6.2; 95% confidence interval, 0.7 -52.5 p=0.0940) among patients treated with endovascular modality. . Conclusion: Although the rates of recurrent intracranial hemorrhage related hospitalization were low among patients with ruptured intracranial aneurysms, there was a higher rate among patients treated with endovascular treatment.

scholarly journals Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms

2019 ◽  
Vol 4 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Edgar A Samaniego ◽  
Emilee Gibson ◽  
Daichi Nakagawa ◽  
Santiago Ortega-Gutierrez ◽  
Mario Zanaty ◽  
...  
Keyword(s):  
Platelet Count ◽  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Intracranial Aneurysms ◽  
Dual Antiplatelet Therapy ◽  
Concomitant Administration ◽  
Thromboembolic Complications ◽  
Ruptured Aneurysms ◽  
Increase Rate ◽  
Flow Diverters

BackgroundEndovascular treatment of intracranial aneurysms usually involves stent-assisted coiling (SAC) and flow diverters. Glycoprotein IIb/IIIa inhibitors such as tirofiban and dual antiplatelet therapy (DAPT) are required to prevent thromboembolic complications afterwards. We sought to determine the safety of tirofiban and DAPT in these cases.MethodsWe conducted a retrospective analysis of our database for patients with intracranial aneurysms who underwent SAC or flow diversion. The tirofiban-DAPT protocol used is described. Data regarding duration of infusion, placement of external ventricular devices (EVDs), complications, haemoglobin levels and platelet count before and 24 hours after antiplatelet therapy were collected and analysed.ResultsOne-hundred and forty-one patients with 148 aneurysms/procedures were included. 110 aneurysms were treated acutely and 38 electively. Minor and major haemorrhagic events were recognised in 20% (30/148) aneurysms. Only 5 (3.4%) intracerebral haemorrhages were symptomatic: 3 cortical/SAH and 2 EVD-related. The average blood volume in symptomatic haemorrhages was 24.8 cc versus 5.42 cc in asymptomatic haemorrhages (p=0.002). The rate of EVD-related haemorrhages was 15.7% (19/121) and only 2 (1.7%) were symptomatic. Most haemorrhagic events occurred in ruptured aneurysms (90.1%, p=0.01). No significant change in platelet count or haemoglobin levels before and 24 hours after administration of tirofiban and DAPT was documented. Concomitant administration of heparin did not increase haemorrhagic events.ConclusionThe use of the GP IIb/IIIa inhibitors tirofiban and DAPT in this series was safe. Tirofiban and DAPT did not affect platelet count or haemoglobin levels and did not increase rate of symptomatic haemorrhages or thromboembolic complications.

Abstract WP297: National Estimates of Recurrent Intracranial Hemorrhage Among Patients With Ruptured Intracranial Aneurysms

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Iqra A Akhtar ◽  
Werdah Zafar ◽  
Yun Fang ◽  
Ameer E Hassan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Hemorrhage ◽  
Intracranial Aneurysms ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Ruptured Intracranial Aneurysm ◽  
Hospitalization Period ◽  
Nationally Representative ◽  
Ruptured Intracranial Aneurysms

Background: The estimates of recurrent intracranial hemorrhage in the post-hospitalization period among patients treated for ruptured intracranial aneurysms are not available outside clinical trials. Objective: To determine the rates of recurrent intracranial hemorrhage related hospitalization within 3 month post-hospitalization for treatment of ruptured intracranial aneurysm in a nationwide cohort of patients admitted for subarachnoid hemorrhage (SAH). Methods: We identified all readmissions related to new SAH or intracerebral hemorrhage in the nationally representative data for all patients hospitalized for SAH using the Nationwide Readmissions Database (NRD) 2013 and 2014 who had undergone endovascular or surgical treatment. Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent intracranial hemorrhage for patients in treatment cohorts after adjusting for potential confounders. The 1-year survival was estimated for both treatment groups by using the Kaplan-Meier survival method. Results: A total of 8,619 patients with SAH were treated with either endovascular (n = 4,102, 47.6%) or surgical treatment (n =4,517; 52.4%).. The estimated 3 months recurrent intracranial hemorrhage survival was 99.4% and 98.4% in patients who underwent surgical and endovascular treatments, respectively (p=0.0024). After adjusting for age>65, and APDRG severity score, the RRs of recurrent any intracranial hemorrhage was higher with endovascular treatment (RR, 3.0; 95% confidence interval (CI), 1.4 -6.7 p=0.0052). Conclusion: Although the rates of recurrent intracranial hemorrhage related hospitalization were low among patients with ruptured intracranial aneurysms, there was a higher rate among patients treated with endovascular treatment.

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