Key result
Dual antiplatelet treatment was associated with a significantly lower incidence of symptomatic vasospasm (1.5% vs 12.9%) and delayed cerebral ischemia (1.5% vs 10.9%) compared to no antiplatelet treatment in patients with aneurysmal subarachnoid hemorrhage.
Why the study?
Platelet activation has been hypothesized to contribute to cerebral vasospasm and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage, prompting investigation into whether dual antiplatelet treatment affects these complications.
Does dual antiplatelet treatment reduce the incidence of symptomatic vasospasm and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage?
Cohort (n=166)
No
Does dual antiplatelet treatment reduce the incidence of symptomatic vasospasm and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage?
Absolute Event Rate: 1.5% vs 12.9%
p-value: p=0.010
Dual antiplatelet therapy may reduce the risk of symptomatic vasospasm and delayed cerebral ischemia in patients undergoing coil embolization for aneurysmal subarachnoid hemorrhage.
DAPT was associated with lower symptomatic vasospasm and DCI rates in stent-coiled aSAH; leaves open need for RCTs before practice change.
OBJECTIVE: Cerebral vasospasm and delayed cerebral ischemia (DCI) are considered complications after aneurysmal subarachnoid hemorrhage (aSAH). Several hypotheses involving platelet activation have been asserted in the pathophysiology of cerebral vasospasm and DCI. This study aimed to investigate the effect of dual antiplatelet treatment (DAPT) on symptomatic vasospasm and DCI in patients with aSAH. METHODS: A retrospective study was conducted on patients with aSAH from 2009 to 2018. The patients are divided into 2 groups according to the treatment method such as simple or balloon-assisted coil embolization group (SB coiling), and stent-assisted coil embolization group. Patients treated by SB coiling without DAPT were classified as the control group. Patients who required dual antiplatelet treatment due to stent-assisted coil embolization were classified as DAPT group. The incidence of symptomatic vasospasm and DCI was compared between the two groups. RESULTS: Of 743 patients with aSAH, 563 patients were treated with clipping, 115 patients treated with SB coiling, and 65 patients receive stent-assisted coiling. Among 115 patients underwent SB coiling, 14 patients were excluded by the exclusion criteria. Total number of control group (SB coiling) was 101, DAPT group (stent-assisted coiling) was 65. Depending on whether or not taking DAPT, the incidence of symptomatic vasospasm was lower in the DAPT group (p=0.010). DCI incidence was also lower in the DAPT group, which was statistically significant (p=0.029). CONCLUSIONS: DAPT reduces the frequency of symptomatic vasospasm and DCI in patients with aSAH in our single-center study. To warranting this topic, further, larger prospective and randomized studies should be needed.
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Sun et al. (2020) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=166). Dual antiplatelet treatment (aspirin and clopidogrel) vs. No dual antiplatelet treatment (simple or balloon-assisted coiling) was evaluated on Incidence of symptomatic vasospasm (p=0.010). Dual antiplatelet treatment was associated with a significantly lower incidence of symptomatic vasospasm (1.5% vs 12.9%) and delayed cerebral ischemia (1.5% vs 10.9%) compared to no antiplatelet treatment in patients with aneurysmal subarachnoid hemorrhage.
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