Abstract WP75: Dual Antiplatelet Therapy in Addition to Post-Operative Heparin and Dextran Reduces Clinically Symptomatic Thromboembolic Events During Elective Aneurysm Coiling
BACKGROUND: Thromboembolism is a feared complication of coiling a cerebral aneurysm. The purpose of this study was to compare the thromboembolic events between cerebral aneurysms coiled with an anti-thromboembolic regimen versus those with no regimen.
METHODS: This retrospective cohort study included all adult patients who underwent elective coiling of an intracranial aneurysm between January 1, 2005 and February 1, 2012. All aneurysms were treated with conventional coiling. Patients were started on aspirin and clopidogrel for seven days prior to treatment with aspirin continued indefinitely and clopidogrel for 4 weeks post-coiling. During the coiling procedure patients were given heparin to maintain an activated clotting time 2.5x baseline. Additionally, dextran-40 and heparin were infused for 24 hours post coil placement. The primary endpoint was the presence of a clinically significant thromboembolic event as determine by physical exam and/or MRI diffusion weighted imaging. Each variable was analyzed for its independent association with the occurrence of an embolic event.
RESULTS: 312 aneurysms were electively treated. 261 of 312 aneurysms received our anti-thromboembolic regimen versus 51 who did not. There were a total of 6 (1.9%) embolic events. Patients who received the anti-thromboembolic regimen had 3 (1.1%) embolic events versus 3 (5.9%) in those not receiving the regimen (p = 0.024). Patients receiving the anti-thromboembolic regimen had significantly more active tobacco use but the two groups did not differ in age, sex, or the presence of obesity, diabetes, or hypercoagulable state. There was no difference in the occurrence of central nervous system or systemic hemorrhages between the two groups. In univariate analysis, the presence of a hypercoagulable state (p = 0.014) and the lack of anti-embolic regimen (p = 0.043) were associated with the occurrence of an embolic event. Both remained significant in multivariate analysis (p = 0.016 and p = 0.048, respectively).
CONCLUSION: An anti-thromboembolic regimen consisting of dual antiplatelet therapy plus post-operative heparin and dextran reduced the risk of embolic events during elective aneurysm coiling. This regimen was safe, with no observed increase in hemorrhagic complications.
- © 2012 by American Heart Association, Inc.