Skip to main content
SpringerLink
Log in

Anticoagulation and Antiplatelet Treatments Related to Endovascular Treatment of Aneurysms

  • Chapter
  • First Online:
Eight Aneurysms

  • 286 Accesses

Abstract

Anticoagulation (AC) and antiplatelet (AP) treatments are commonly used in the endovascular treatment of brain aneurysms. AC and AP treatments comprise a critical part of many neuroendovascular procedures, and using them appropriately can significantly influence the outcome of the endovascular treatment. Many questions regarding AC and AP, such as how to manage the pre-existing AC and AP before the planned procedure, when to resume AC/AP treatment after the endovascular procedure, and intraoperative AP and AC treatment, are not agreed upon in practice.

In this chapter, the following issues are discussed along with an extensive review of the current literature:

  1. 1.

    Management of AC and AP prior to angiogram and neuroendovascular intervention.

  2. 2.

    AP for neuroendovascular intervention procedures and commonly used AP medications.

  3. 3.

    Intraoperative AC and AP need.

  4. 4.

    Post-angiogram/intervention AC and AP treatment.

  5. 5.

    Perioperative dual antiplatelet management for ruptured aneurysms.

  6. 6.

    Surface coating device.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Oneissi M, Sweid A, Tjoumakaris S, et al. Access-site complications in Transfemoral Neuroendovascular procedures: a systematic review of incidence rates and management strategies. Oper Neurosurg (Hagerstown). 2020;19(4):353–63.

    Article  Google Scholar 

  2. Kim KS, Fraser JF, Grupke S, Cook AM. Management of antiplatelet therapy in patients undergoing neuroendovascular procedures. J Neurosurg. 2018;129(4):890–905.

    Article  CAS  PubMed  Google Scholar 

  3. Tan LA, Keigher KM, Munich SA, Moftakhar R, Lopes DK. Thromboembolic complications with pipeline embolization device placement: impact of procedure time, number of stents and pre-procedure P2Y12 reaction unit (PRU) value. J Neurointerv Surg. 2015;7(3):217–21.

    Article  PubMed  Google Scholar 

  4. Fifi JT, Brockington C, Narang J, et al. Clopidogrel resistance is associated with thromboembolic complications in patients undergoing neurovascular stenting. AJNR Am J Neuroradiol. 2013;34(4):716–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Qureshi AI, Luft AR, Sharma M, Guterman LR, Hopkins LN. Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: part I--pathophysiological and pharmacological features. Neurosurgery. 2000;46(6):1344–59.

    Article  CAS  PubMed  Google Scholar 

  6. Bomberger RA, DePalma RG, Ambrose TA, Manalo P. Aspirin and dipyridamole inhibit endothelial healing. Arch Surg. 1982;117(11):1459–64.

    Article  CAS  PubMed  Google Scholar 

  7. Ranganathan S, Joseph J, Mehta JL. Aspirin inhibits human coronary artery endothelial cell proliferation by upregulation of p53. Biochem Biophys Res Commun. 2003;301(1):143–6.

    Article  CAS  PubMed  Google Scholar 

  8. Mohammaden MH, English SW, Stapleton CJ, et al. Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the pipeline embolization device (PED): multicenter experience. J Neurointerv Surg. 2020;12(11):1113–6.

    Article  PubMed  Google Scholar 

  9. Tonetti DA, Jankowitz BT, Gross BA. Antiplatelet therapy in flow diversion. Neurosurgery. 2020;86(Suppl 1):S47–52.

    Article  PubMed  Google Scholar 

  10. Hanel RA, Taussky P, Dixon T, et al. Safety and efficacy of ticagrelor for neuroendovascular procedures. A single center initial experience. J Neurointerv Surg. 2014;6(4):320–2.

    Article  PubMed  Google Scholar 

  11. Delgado Almandoz JE, Kadkhodayan Y, Crandall BM, Scholz JM, Fease JL, Tubman DE. Variability in initial response to standard clopidogrel therapy, delayed conversion to clopidogrel hyper-response, and associated thromboembolic and hemorrhagic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms. J Neurointerv Surg. 2014;6(10):767–73.

    Article  PubMed  Google Scholar 

  12. Bonello L, Tantry US, Marcucci R, et al. Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol. 2010;56(12):919–33.

    Article  CAS  PubMed  Google Scholar 

  13. Tantry US, Bonello L, Aradi D, et al. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol. 2013;62(24):2261–73.

    Article  CAS  PubMed  Google Scholar 

  14. Delgado Almandoz JE, Crandall BM, Scholz JM, et al. Last-recorded P2Y12 reaction units value is strongly associated with thromboembolic and hemorrhagic complications occurring up to 6 months after treatment in patients with cerebral aneurysms treated with the pipeline embolization device. AJNR Am J Neuroradiol. 2014;35(1):128–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Delgado Almandoz JE, Crandall BM, Scholz JM, et al. Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the Pipeline Embolization Device. J Neurointerv Surg. 2013;5(Suppl 3):iii3–10.

    Google Scholar 

  16. Goh C, Churilov L, Mitchell P, Dowling R, Yan B. Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. AJNR Am J Neuroradiol. 2013;34(4):721–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Brinjikji W, Lanzino G, Cloft HJ, Siddiqui AH, Hanel RA, Kallmes DF. Platelet testing is associated with worse clinical outcomes for patients treated with the pipeline embolization device. AJNR Am J Neuroradiol. 2015;36(11):2090–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Akbari SH, Reynolds MR, Kadkhodayan Y, Cross DT 3rd, Moran CJ. Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures. J Neurointerv Surg. 2013;5(4):337–43.

    Article  PubMed  Google Scholar 

  19. Alexopoulos D, Galati A, Xanthopoulou I, et al. Ticagrelor versus prasugrel in acute coronary syndrome patients with high on-clopidogrel platelet reactivity following percutaneous coronary intervention: a pharmacodynamic study. J Am Coll Cardiol. 2012;60(3):193–9.

    Article  CAS  PubMed  Google Scholar 

  20. Alexopoulos D, Xanthopoulou I, Gkizas V, et al. Randomized assessment of ticagrelor versus prasugrel antiplatelet effects in patients with ST-segment-elevation myocardial infarction. Circ Cardiovasc Interv. 2012;5(6):797–804.

    Article  CAS  PubMed  Google Scholar 

  21. Gurbel PA, Bliden KP, Butler K, et al. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation. 2010;121(10):1188–99.

    Article  CAS  PubMed  Google Scholar 

  22. Kayan Y, Delgado Almandoz JE, Fease JL, Milner AM, Scholz JM, Mulder M. Efficacy of a two-test protocol for achieving a therapeutic response to clopidogrel prior to elective endovascular intracranial aneurysm treatment and an 'induced' postoperative hyper-response. J Neurointerv Surg. 2017;9(8):792–6.

    Article  PubMed  Google Scholar 

  23. Gonzalez A, Ortega-Quintanilla J, Zapata-Arriaza E, et al. Dose adjustment of clopidogrel in hyper-responder patients with unruptured intracranial aneurysms treated with stents. J Neurointerv Surg. 2020;12(5):499–504.

    Article  PubMed  Google Scholar 

  24. Brinjikji W, Morales-Valero SF, Murad MH, Cloft HJ, Kallmes DF. Rescue treatment of thromboembolic complications during endovascular treatment of cerebral aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2015;36(1):121–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Ries T, Siemonsen S, Grzyska U, Zeumer H, Fiehler J. Abciximab is a safe rescue therapy in thromboembolic events complicating cerebral aneurysm coil embolization: single center experience in 42 cases and review of the literature. Stroke. 2009;40(5):1750–7.

    Article  CAS  PubMed  Google Scholar 

  26. Song JK, Niimi Y, Fernandez PM, et al. Thrombus formation during intracranial aneurysm coil placement: treatment with intra-arterial abciximab. AJNR Am J Neuroradiol. 2004;25(7):1147–53.

    PubMed  PubMed Central  Google Scholar 

  27. Bruening R, Mueller-Schunk S, Morhard D, et al. Intraprocedural thrombus formation during coil placement in ruptured intracranial aneurysms: treatment with systemic application of the glycoprotein IIb/IIIa antagonist tirofiban. AJNR Am J Neuroradiol. 2006;27(6):1326–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Adeeb N, Griessenauer CJ, Moore JM, et al. Ischemic stroke after treatment of Intraprocedural thrombosis during stent-assisted coiling and flow diversion. Stroke. 2017;48(4):1098–100.

    Article  PubMed  Google Scholar 

  29. Jun HS, Ahn JH, Kim JH, Oh JK, Song JH, Chang IB. Thrombus remnant despite intra-arterial thrombolysis for thrombus formation during endovascular treatment of ruptured cerebral aneurysms: does it harm? Interv Neuroradiol. 2016;22(4):407–12.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hwang G, Kim JG, Song KS, et al. Delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysm: characteristics and optimal duration of preventative dual antiplatelet therapy. Radiology. 2014;273(1):194–201.

    Article  PubMed  Google Scholar 

  31. Rossen JD, Chalouhi N, Wassef SN, et al. Incidence of cerebral ischemic events after discontinuation of clopidogrel in patients with intracranial aneurysms treated with stent-assisted techniques. J Neurosurg. 2012;117(5):929–33.

    Article  CAS  PubMed  Google Scholar 

  32. Nagahama Y, Allan L, Nakagawa D, et al. Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia. J Neurosurg. 2018;129(3):702–10.

    Article  PubMed  Google Scholar 

  33. Sun GU, Park E, Kim DW, Kang SD. Dual antiplatelet treatment associated with reduced risk of symptomatic vasospasm and delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. J Cerebrovasc Endovasc Neurosurg. 2020;22(3):134–40.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Darkwah Oppong M, Gembruch O, Pierscianek D, et al. Post-treatment antiplatelet therapy reduces risk for delayed cerebral ischemia due to aneurysmal subarachnoid hemorrhage. Neurosurgery. 2019;85(6):827–33.

    Article  PubMed  Google Scholar 

  35. Ospel JM, Brouwer P, Dorn F, et al. Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of ruptured intracranial aneurysms: a DELPHI consensus statement. AJNR Am J Neuroradiol. 2020;41(10):1856–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Hudson JS, Nagahama Y, Nakagawa D, et al. Hemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis. J Neurosurg. 2018;129(4):916–21.

    Article  CAS  PubMed  Google Scholar 

  37. Kim JH, Choi JI. Perioperative dual antiplatelets management for ventriculoperitoneal shunt operation in patients with hydrocephalus after stent-assisted coil embolization of the ruptured intracranial aneurysm. Clin Neurol Neurosurg. 2020;195:106067.

    Article  PubMed  Google Scholar 

  38. Higashi E, Hatano T, Ando M, et al. Thrombosis of large aneurysm induced by flow-diverter stent and dissolved by direct factor Xa inhibitor. World Neurosurg. 2019;131:209–12.

    Article  PubMed  Google Scholar 

  39. Pikis S, Mantziaris G, Mamalis V, et al. Diffusion weighted image documented cerebral ischemia in the postprocedural period following pipeline embolization device with shield technology treatment of unruptured intracranial aneurysms: a prospective, single center study. J Neurointerv Surg. 2020;12(4):407–11.

    Article  PubMed  Google Scholar 

  40. Bond KM, Brinjikji W, Murad MH, Kallmes DF, Cloft HJ, Lanzino G. Diffusion-weighted imaging-detected ischemic lesions following endovascular treatment of cerebral aneurysms: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38(2):304–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Manning NW, Cheung A, Phillips TJ, Wenderoth JD. Pipeline shield with single antiplatelet therapy in aneurysmal subarachnoid haemorrhage: multicentre experience. J Neurointerv Surg. 2019;11(7):694–8.

    Article  PubMed  Google Scholar 

  42. Cagnazzo F, di Carlo DT, Cappucci M, Lefevre PH, Costalat V, Perrini P. Acutely ruptured intracranial aneurysms treated with flow-diverter stents: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39(9):1669–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Guzzardi G, Galbiati A, Stanca C, et al. Flow diverter stents with hydrophilic polymer coating for the treatment of acutely ruptured aneurysms using single antiplatelet therapy: preliminary experience. Interv Neuroradiol. 2020;26(5):525–31.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Bhogal P, Bleise C, Chudyk J, et al. The p48_HPC antithrombogenic flow diverter: initial human experience using single antiplatelet therapy. J Int Med Res. 2020;48(1):300060519879580.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Affiliated Hospital of Guiyang Medical University, Guiyang, Guizhou, China

    Zeguang Ren

Authors
  1. Zeguang Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ren, Z. (2022). Anticoagulation and Antiplatelet Treatments Related to Endovascular Treatment of Aneurysms. In: Eight Aneurysms. Springer, Cham. https://doi.org/10.1007/978-3-030-97216-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-97216-5_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-97215-8

  • Online ISBN: 978-3-030-97216-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation