Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms.
J Neurointerv Surg
; 8(11): 1148-1153, 2016 Nov.
Article
em En
| MEDLINE
| ID: mdl-26614492
ABSTRACT
BACKGROUND:
Coil embolization of intracranial aneurysms is being increasingly used; however, thromboembolic events have become a major periprocedural complication.OBJECTIVE:
To determine the safety and efficacy of prophylactic tirofiban in patients with ruptured intracranial aneurysms.METHODS:
Tirofiban was administered as an intravenous bolus (8.0â µg/kg over 3â min) followed by a maintenance infusion (0.10â µg/kg/min) before stent deployment or after completion of single coiling. Dual oral antiplatelet therapy (loading doses) was overlapped with half the tirofiban dose 2â h before cessation of the tirofiban infusion. Cases of intracranial hemorrhage or thromboembolism were recorded.RESULTS:
Tirofiban was prophylactically used in 221 patients, including 175 (79.19%) who underwent stent-assisted coiling and 46 (20.81%) who underwent single coiling, all in the setting of aneurysmal subarachnoid hemorrhage. Six (2.71%) cases of intracranial hemorrhage occurred, including four (1.81%) tirofiban-related cases and two (0.90%) antiplatelet therapy-related cases. There were two (0.90%) cases of fatal hemorrhage, one related to tirofiban and the other related to dual antiplatelet therapy. Thromboembolic events occurred in seven (3.17%) patients (6 stent-assisted embolization, 1 single coiling), of which one (0.45%) event occurred during stenting and six (2.72%) occurred during intravenous tirofiban maintenance. No thromboembolic events related to dual antiplatelet therapy were found.CONCLUSIONS:
Tirofiban bolus over 3â min followed by maintenance infusion appears to be a safe and efficient prophylactic protocol for the endovascular treatment of ruptured intracranial aneurysms and may be an alternative to intraoperative oral antiplatelet therapy, especially in the case of stent-assisted embolization.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Tirosina
/
Aneurisma Intracraniano
/
Aneurisma Roto
/
Procedimentos Endovasculares
/
Profilaxia Pré-Exposição
/
Cuidados Intraoperatórios
Tipo de estudo:
Guideline
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article