Abstract 3464: Incidence of Cerebral Ischemia After Discontinuation Of Clopidogrel (Plavix) In Patients With Cerebral Aneurysms Treated Using Stent-Assisted Technique

Abstract

Background: The optimal antiplatelet medication protocol for prevention of thrombotic complications after stent-assisted coil embolization of cerebral aneurysms is unknown. Premature cessation of antiplatelet medication has been associated with increased risk of thrombosis. The current analysis is undertaken to assess the incidence of stroke or transient ischemic attack after discontinuation of 6 weeks of prescribed clopidogrel (Plavix) in patients with cerebral aneurysms treated by stent-assisted technique. Method: 275 patients with cerebral aneurysms treated at the University of Iowa Hospitals and Clinics by a single surgeon (DH) during a period of 24 months were retrospectively analyzed for aneurysms treated by stent-assisted coiling or stent-in-stent flow diversion and who also received follow-up at our center. Our antiplatelet protocol was aspirin 81 mg PO and plavix 75 mg PO daily for 6 weeks, followed by aspirin 325 mg PO daily indefinitely. Patients were assessed for incidence of stroke or transient ischemic attack as diagnosed by a neurologist or neurosurgeon by reviewing their medical record during the period of three months following discontinuation of plavix. Results: 154/275 (56%) patients underwent stent-assisted coil embolization during this interval. Documentation of neurologic follow-up after discontinuation of six-weeks of palvix treatment was available in 121/154 (78.6%) patients. Seven patients suffered an ischemic event after cessation of plavix (5.7%) with stroke in 6 patients (5.0%) and transient ischemic attack in 1 patient (0.8%). These events developed over a wide range of intervals from time of plavix discontinuation (1-12 weeks), with only one event within 2 weeks. Conclusion: The three-month incidence of cerebral ischemic events in patients treated with stent-assisted technique is low following cessation of six-week treatment of plavix. Events within two weeks of discontinuation were rare, suggesting etiologies other than stent thrombosis may have been operative in our patients.