Abstract WMP33: Peri-operative Dual Antiplatelet Therapy for the Coil Embolization of Unruptured Brain Aneurysms: The Efficacy and the Side Effect

Abstract

Backgrounds: Optimal dose and duration of antiplatelet therapy before / after the coil embolization of unruptured aneurysm has not been established, yet. The dual antiplatelet therapy (DAPT) using aspirin and clopidogrel started 3 to 7 days before operation has been a commonly used antiplatelet protocol, although few studies have done to evaluate the relationship between the duration of the pre-operative DAPT and its efficacy / side effects. In the present study, the different durations of the pre-operative DAPT and their related “efficacy / side effect” was retrospectively analyzed. Method: A total of 232 unruptured brain aneurysm patients (male, n=62; median age, 61 y) who underwent coil embolization were enrolled in this study. Fifty-two (22%) patients underwent stent assisted coil embolization. The patients were categorized into 3 different groups depending on the duration of the DAPT: Group A (within 3days), Group B (4-6 days) and Group C (7 days or longer). The platelet aggregation profiles are evaluated on the day of procedure. Post-operative MRI, the neurological findings and the peri-operative hemorrhagic events between the 3 groups were compared. Results: Diffusion weighted image (DWI) performed the day after the operation showed that 169 (73%) patients had any high intensity lesion in the ipsilateral perfusion area of the treated artery, and 8 (3%) represented symptomatic infarction. The both adenosine diphosphate (ADP) and collagen aggregation were significantly decreased in the group of longest DAPT period (vs Group A (ADP; 45% vs 15%, P <0001, collagen 99% vs 90% P =0.008), vs Group B (ADP; 45% vs 27%, P =0.032, collagen 99% vs 94%, P =0.137)). The symptomatic infarction after operation tended to decrease with longer DAPT period without statistical significance. The rate of hemorrhagic complication was not increased by the longer DAPT period during the observation period. Conclusion: Longer DAPT period significantly reduced both the ADP and collagen aggregation. The rate of symptomatic thromboembolic event tended to decrease with longer DAPT period without statistical significance. With increased number of patient, longer DAPT protocol may reduce the thromboembolic event without increasing the hemorrhagic complication rate.