Abstract TP545: Continuous Intravenous Tirofiban in Patient With Aneurysmal Subarachnoid Hemorrhage Requiring External Ventricular Drain and Ventriculoperitoneal Shunts

Abstract

Introduction: Due to advancements in the field of endovascular neurosurgery, use of intracranial stenting and flow diversion (ISFD) in the treatment of acute aneurysmal subarachnoid hemorrhage (aSAH) is on the rise. ISFD requires dual antiplatelet therapy (DAPT), which poses a challenge when patients undergo placement of an external ventricular drain (EVD) or ventriculo-peritoneal-shunt (VPS). We describe our experience with the use of intravenous tirofiban in similar settings. Methods: Patients with aSAH between July 2017 and June 2018 requiring intravenous tirofiban for ISFD after EVD placement and subsequent VPS were included in our retrospective study. Patients were started on intravenous tirofiban at maintenance dose prior to IFSD and continued until transitioned to DAPT after removal of EVD with or without VPS. Intravenous tirofiban was held 4 hours prior to EVD removal/VPS placement and resumed 2 hours later followed by loading dose of DAPT. Patients were monitored in ICU and CT head obtained 24-hours after the procedure. Results: 15 patients (mean age 55 years, 14 females and 1 male) with aSAH who required ISFD and were placed on intravenous tirofiban for 3-18 days. In total, 21 procedures were performed with placement of 16 EVDs (one patient had bilateral EVDs) and 5 VPS. Two patients had clinically asymptomatic small track hemorrhages and 1 patient had a retroperitoneal hemorrhage and thrombocytopenia. No thromboembolic complications were reported. We encountered an 18% risk of hemorrhages, which compares favorably to our previously published 22% risk of all hemorrhages with DAPT. Conclusions: The continuous infusion of tirofiban in patients with aSAH who require ISFD is feasible and has hemorrhagic complication rate similar to the use of DAPT.