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: Xiao-Dong Liang, Zi-Liang Wang, Tian-Xiao Li, Ying-Kun He, Wei-Xing Bai, Yang-Yang Wang, Guo-Yu Zhou
• Journal: Journal of neurointerventional surgery (J Neurointerv Surg) Vol. 8 Issue 11 Pg. 1148-1153 (Nov 2016) ISSN: 1759-8486 [Electronic] England
• PMID: 26614492 (Publication Type: Journal Article)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Chemical References

• Platelet Aggregation Inhibitors
• Tyrosine
• Tirofiban

Topics

• Administration, Intravenous
• Administration, Oral
• Adult
• Aged
• Aneurysm, Ruptured (diagnostic imaging, therapy)
• Embolization, Therapeutic (adverse effects, methods)
• Endovascular Procedures (adverse effects, methods)
• Female
• Humans
• Injections, Intravenous
• Intracranial Aneurysm (diagnostic imaging, therapy)
• Intraoperative Care (adverse effects, methods)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage)
• Pre-Exposure Prophylaxis (methods)
• Stents
• Tirofiban
• Treatment Outcome
• Tyrosine (administration & dosage, analogs & derivatives)