on April 23, 2009
Published online before print April 23, 2009, doi: 10.1161/STROKEAHA.108.528802
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on June 15, 2008
From the Departments of Intensive Care (W.M.v.d.B.), Rudolf Magnus Institute of Neuroscience, and the Department of Neurology (A.A., G.J.E.R.) and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, The Netherlands; and the Neurovascular Research Unit (R.S.C.K., A.J.M.), Radcliffe Infirmary, Oxford, UK. * To whom correspondence should be addressed. E-mail: w.m.vandenbergh{at}umcutrecht.nl.
Background and Purpose—Antiplatelets are frequently used during or after endovascular coiling of aneurysm in patients with subarachnoid hemorrhage (SAH). This strategy is based on uncontrolled case series including also patients with unruptured aneurysms or other lesions. We collected data on effectiveness of antiplatelets in patients with SAH. Methods—All 43 participating centers in the International Subarachnoid Aneurysm Trial (ISAT) were sent a questionnaire whether they never, sometimes, or always prescribed antiplatelets during or after coiling. Based on individual patient data, the relative risks (RRs) of coiling versus clipping were calculated separately for patients treated in hospitals with standard prescription during or after coiling versus patients treated in hospitals with no standard prescription of antiplatelets. We calculated ratios of RRs for standard versus not standard prescription of antiplatelets during coiling and for standard versus not standard prescription after coiling. Results—Nineteen centers responded, representing 1422 (66%) of the 2143 ISAT patients. Antiplatelets were standard prescribed during coiling in 2 responding centers (8% of coiled patients) and after coiling in 6 centers (24%). For poor outcome at 2 months of coiling versus clipping the RR was 0.82 (95% CI: 0.45 to 1.49) in hospitals with a policy of antiplatelet prescription during coiling versus 0.66 (95% CI: 0.55 to 0.78) in those without such policy (ratio of RR's 1.24, P=0.56). The ratio of RRs for 1-year outcome was 1.01 (P=0.89) for antiplatelet use during coiling and 1.00 (P=0.77) for use after coiling. Conclusion—The results of this study do not support the assumption that antiplatelets during or after endovascular coiling improve outcome in patients with SAH.
Revised on September 7, 2008
Accepted on October 23, 2008
Effect of Antiplatelet Therapy for Endovascular Coiling in Aneurysmal Subarachnoid Hemorrhage
Walter M. van den Bergh MD, PhD*;
Key words: aneurysms • antiplatelet drugs • endovascular treatment • subarachnoid hemorrhage