Effect of Antiplatelet Therapy on Thromboembolic Complications of Elective Coil Embolization of Cerebral Aneurysms

N.K Yamada,R.G Dacey,C.P Derdeyn,C.J Moran,D.T Cross,T.K Pilgram

doi:10.3174/ajnr.a0641

Abstract

Thromboembolic events are the most common complications of elective coil embolization of cerebral aneurysms. Administration of oral clopidogrel and/or aspirin could lower the thromboembolic complication rate. Records over a 10-year period were reviewed in a retrospective cohort study. For 369 consecutive elective coil embolization procedures, 25 patients received no antiplatelet drugs, 86 received antiplatelet drugs only after embolization, and 258 received antiplatelet drugs before and after embolization. Symptomatic thromboembolic complications (transient ischemic attack or stroke within 60 days) occurred in 4 (16%) of 25 when no antiplatelet drugs were given, in 2 (2.3%) of 86 when antiplatelet drugs were administered only after embolization, and in 5 (1.9%) of 258 when antiplatelet drugs were administered before and after embolization. The lower symptomatic thromboembolic complication rate in the patients who received any antiplatelet therapy was statistically significant (P = .004). Clots were visible intraprocedurally in 5 (4.5%) of 111 when no antiplatelet drugs were administered before procedures and in 4 (1.6%) of 258 when they were (P value not significant). None of the 9 was symptomatic postprocedurally, but 7 were lysed or mechanically disrupted. Extracerebral hemorrhagic complications occurred in 0 (0%) of 25 when no antiplatelet drugs were given and in 11 (3.2%) of 344 when they were (P value not significant). Oral clopidogrel and/or aspirin significantly lowered the symptomatic thromboembolic complication rate of elective coil embolization of unruptured cerebral aneurysms. There were trends toward a lower rate of intraprocedural clot formation in patients given antiplatelet drugs before procedures and a higher hemorrhagic complication rate in patients given antiplatelet drugs. Benefits of antiplatelet therapy appear to outweigh risks.

Highlights

AND PURPOSE: Thromboembolic events are the most common complications of elective coil embolization of cerebral aneurysms
Antiplatelet drugs, including aspirin and clopidogrel (Plavix), are widely prescribed for elective endovascular treatment of cerebral aneurysms in an effort to lower the thromboembolic complication rate, but data reported to support that practice are currently limited to 1 study in which intravenous aspirin was used.[2]
We sought to determine whether the administration of oral antiplatelet agents lowered the thromboembolic complication rate or increased the hemorrhagic complication rate resulting from elective coil embolization of cerebral aneurysms through a retrospective review of clinical data

Summary

Methods

For 369 consecutive elective coil embolization procedures, 25 patients received no antiplatelet drugs, 86 received antiplatelet drugs only after embolization, and 258 received antiplatelet drugs before and after embolization. Endovascular treatment procedure logs and departmental patient listings were reviewed to identify all of the patients who underwent elective coil embolization of cerebral aneurysms at our. Drug Regimens All of the patients were systemically anticoagulated with intravenous heparin during coil embolization procedures with initial boluses of 70 –100 U/kg followed by continuous infusions of 7–10 U/kg per hour. Patients given antiplatelet drugs always received oral aspirin, 81 or 325 mg daily, unless contraindicated by an aspirin allergy. Since 1999, when clopidogrel became available, many patients received clopidogrel for 3–5 days before their procedures. Patients treated after procedures were generally given aspirin permanently and clopidogrel for 30 – 60 days

Results

Discussion

Conclusion