Key result
Arteriovenous tirofiban administration was associated with lower incidences of perioperative thromboembolic (overall 5.04%) and hemorrhagic events (overall 15.83%) compared to oral DAPT.
Why the study?
Antiplatelet protocols play a key role in preventing major perioperative thromboembolic and hemorrhagic complications during stent-assisted embolization for aneurysmal subarachnoid hemorrhage.
Does arteriovenous tirofiban administration reduce perioperative thromboembolic and hemorrhagic events compared to oral DAPT in patients with aneurysmal subarachnoid hemorrhage undergoing stent-assisted embolization?
Cohort (n=417)
No
Does arteriovenous tirofiban administration reduce perioperative thromboembolic and hemorrhagic events compared to oral DAPT in patients with aneurysmal subarachnoid hemorrhage undergoing stent-assisted embolization?
Arteriovenous tirofiban may be a safer and effective alternative to oral DAPT for preventing perioperative thromboembolic events without increasing hemorrhagic risk in patients undergoing stent-assisted embolization for ruptured intracranial aneurysms.
Answers are grounded in this paper and cite their sources.
Tirofiban was associated with fewer events than DAPT; leaves open its role versus oral DAPT pending randomized confirmation.
BACKGROUND: Major perioperative complications of stent-assisted embolization treated for aneurysmal subarachnoid hemorrhage patients include the formation of thromboembolic events (TEs) and hemorrhagic events (HEs), for which antiplatelet protocols play a key role. METHODS: We conducted a single-center retrospective analysis to compare the differences between arteriovenous tirofiban administration with traditional oral dual antiplatelet therapy (DAPT). A total of 417 consecutive patients were enrolled. General clinical characteristics, as well as the perioperative ischemic and hemorrhagic events, were retracted in digital documents. Logistic regression was conducted to identify both risk and protective factors of perioperative TEs and HEs. RESULTS: Perioperative TEs occurred in 21 patients, with an overall perioperative TEs rate of approximately 5.04%; among these patients, the incidence of perioperative TEs in the tirofiban group was less than that in the DAPT group. Additionally, 66 patients developed perioperative HEs, with an incidence of approximately 15.83%; among these patients, the incidence of perioperative HEs was less than that in the DAPT group. No significant differences were seen between the two groups in terms of the mRS score at the time of discharge. CONCLUSION: This study indicated that an improved perioperative antiplatelet drug tirofiban was an independent protective factor for perioperative TEs in stent-assisted embolization of ruptured intracranial aneurysms, but it did not impart an elevated risk of perioperative HEs and had no significant effects on the near-term prognosis of the patients.
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Wang et al. (2024) conducted a cohort in Aneurysmal subarachnoid hemorrhage treated with stent-assisted embolization (n=417). Arteriovenous tirofiban vs. Oral dual antiplatelet therapy (DAPT) was evaluated on Perioperative thromboembolic events (TEs) and hemorrhagic events (HEs). Arteriovenous tirofiban administration was associated with lower incidences of perioperative thromboembolic (overall 5.04%) and hemorrhagic events (overall 15.83%) compared to oral DAPT.
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