Background and Purpose:
Stent-assisted coiling (SAC) of
intracranial aneurysms is usually treated with antiplatelet
therapy to reduce the risk of postoperative ischemic events. However, using the same antiplatelet
therapy for all patients may increase the risk of
bleeding in patients with
aneurysmal subarachnoid hemorrhage (aSAH). Thromboelastography-platelet mapping (TEG-PM) measures platelet function, which reflects the effect of
antiplatelet drugs. This study aimed to evaluate the benefits of individualized antiplatelet regimens based on TEG-PM parameters for patients with aSAH who underwent SAC. Methods: We retrospectively included patients with aSAH who treated with SAC during the period from June 2012 to December 2019. Patients were divided into two groups: patients whose antiplatelet
therapy adjusted by TEG-PM parameters after surgery (adjustment group) and patients who were treated with standard dual antiplatelet
therapy without TEG-PM test (control group). The occurrence of major/minor
bleeding events, major/minor thromboembolic events, and favorable outcome (modified Rankin scale <3) were compared in both groups during hospitalization. Results: Of 188 aSAH patients considered for this study, 145 met the criteria for inclusion and were included in the analysis (93 patients in the adjustment group and 52 patients in the control group). The risks of minor
bleeding events (1.1 vs. 9.6%, p = 0.02) were significantly lower in patients in the adjustment group. However, there was no significant difference in the rate of major
bleeding events at discharge between adjustment and control groups (p = 0.35). The rates of thromboembolic events and favorable outcome were similar in both groups (22.6 vs. 28.8%, p = 0.42, 95.7 vs. 96.2%, p = 1.00). Furthermore, the minor thromboembolic events rate was significantly lower in the patients treated with treatment plan C (p = 0.02 for treatment plan C vs. treatment A, p = 0.03 for treatment plan C vs. treatment
plan B). However, there was no significant difference in the rate of other mentioned above complications and favorable outcomes among patients treated with different antiplatelet regimens. Conclusions: Individualized antiplatelet
therapy based on TEG-PM parameters might positively impact the
bleeding risk of aSAH patients, without increasing the risk for clinically relevant thromboembolic events.