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Feasibility and safety values of activated clotting time–guided systemic heparinization in coil embolization for unruptured intracranial aneurysms

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Abstract

Objective

This study aimed to evaluate the feasibility and safety values of activated clotting time (ACT)–guided systemic heparinization in reducing periprocedural thrombosis and bleeding complications during coil embolization of unruptured intracranial aneurysms.

Methods

A total of 228 procedures performed on 213 patients between 2016 and 2021 were included in the retrospective analysis. The target ACT was set at 250 s. Logistic regression was performed to assess predictors for the occurrence of thrombosis and bleeding. Receiver operating characteristic (ROC) analyses were employed to determine the optimal cut-off values for ACT, heparinization, and procedure time.

Results

Most (85.1%) of procedures were stent-assisted embolization. The mean baseline ACT was 128.8 ± 45.7 s. The mean ACT at 20 min after the initial intravenous heparin loading of 78.2 ± 18.8 IU/kg was 185 ± 46.4 s. The mean peak ACT was 255.6 ± 63.8 s with 51.3% (117 cases) achieving the target ACT level. Peak ACT was associated with symptomatic thrombosis (OR per second, 1.008; 95% CI, 1.000–1.016; P = 0.035) (cut-off value, 275 s; area under ROC (AUROC), 0.7624). Total administered heparin dose per body weight was negatively associated with symptomatic thrombosis (OR per IU/kg, 0.972; 95% CI, 0.949–0995; P = 0.018) (cut-off value, 294 IU/kg; AUROC, 0.7426) but positively associated with significant bleeding (OR, 1.008 per IU/kg; 95% CI, 1.005–1.012; P <0 .001) (cut-off value, 242 IU/kg; AUROC, 0.7391). Procedure time was significantly associated with symptomatic thrombosis (OR per minute, 1.05; 95% CI, 1.017–1.084; P value = 0.002) (cut-off value, 158 min; area under ROC, 0.8338).

Conclusion

This study demonstrated that ACT-guided systemic heparinization was feasible to achieve the target ACT value and proposes probable safety thresholds to prevent periprocedural complications through reducing procedure time during coil embolization of unruptured intracranial aneurysms in the stent era.

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Data availability

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Acknowledgements

The authors give special thanks to all dedicated members of the neurointervention team at the authors’ center.

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Authors and Affiliations

  1. Department of Neurosurgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon, 21431, Republic of Korea

    Hyuk Jang, Byung-Rae Cho, Dong-Kyu Jang & Dong-Sub Kim

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Contributions

Conceptualization: DKJ; data curation: HJ, DKJ; formal analysis: DKJ; methodology: DKJ; project administration: DKJ; visualization: DKJ; writing original draft: HJ, BRC, DKJ, DSK; writing review and editing; HJ, BRC, DKJ, DSK; HJ and BRC equally contributed to the manuscript writing.

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Correspondence to Dong-Kyu Jang.

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Jang, H., Cho, BR., Jang, DK. et al. Feasibility and safety values of activated clotting time–guided systemic heparinization in coil embolization for unruptured intracranial aneurysms. Acta Neurochir 165, 3743–3757 (2023). https://doi.org/10.1007/s00701-023-05869-z

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