Secondary Risks of Bleeding and Associated Outcome After Tirofiban Application During Interventional Treatment of Intracranial Aneurysms

Introduction Device-assisted endovascular treatment of ruptured aneurysms may require antiplatelet therapy, but bleeding risk is a concern. This retrospective propensity score-matched cohort study investigated whether tirofiban, including prolonged administration for ≥7 days, was associated with secondary bleeding complications. Methods We analyzed 99 patients treated endovascularly aSAB between 2006 and 2024, including 51 patients receiving tirofiban and 48 controls selected using propensity score matching. Tirofiban patients were categorized into short-term treatment (<7 days) and prolonged treatment (≥7 days). Bleeding complications were classified using an adapted Heidelberg bleeding classification and categorized as spontaneous or surgery-associated. Results For the main bleeding endpoints, evaluable data were available for 42 controls, 29 patients with short-term tirofiban, and 18 patients with prolonged tirofiban. Any spontaneous secondary bleeding occurred in 6/42 controls (14%), 2/29 short-term tirofiban patients (7%; p = 0.46), and 1/18 prolonged tirofiban patients (6%; p = 0.66). Surgery-associated bleeding occurred in 13/42 controls (31%), 11/29 short-term tirofiban patients (38%; p = 0.72), and 7/18 prolonged tirofiban patients (39%; p = 0.77). Clinically relevant bleeding occurred in 2/42 controls (5%), 0/29 short-term tirofiban patients (0%; p = 0.51), and 1/18 prolonged tirofiban patients (6%; p = 1.00). Median hospital duration was 21 days in controls, 18 days in short-term, and 31 days in prolonged tirofiban patients. Conclusion In this small retrospective cohort, tirofiban, including prolonged administration for ≥7 days, was not associated with a statistically significant increase in spontaneous, surgery-associated, or clinically relevant secondary bleeding. These exploratory findings require confirmation in larger prospective studies.