Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms.
aneurysm
coil
embolic
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
03
06
2019
revised:
14
08
2019
accepted:
19
08
2019
pubmed:
22
9
2019
medline:
5
8
2020
entrez:
22
9
2019
Statut:
ppublish
Résumé
Thromboembolic events are recognized complications of aneurysm coiling. To identify any protective effects of antiplatelet therapy use before coiling of unruptured aneurysms. We conducted a meta-analysis of clinical studies published up to February 2019. We included studies reporting symptomatic thromboembolic events (defined as clinical stroke or transient ischemic attacks) in patients who received antiplatelet therapy before coiling of unruptured aneurysms using unassisted coiling, balloon assistance, or multiple microcatheters. We excluded ruptured aneurysms and those treated with stent coiling or flow diverters. We identified 14 studies (2486 patients). All were single-center studies and four were prospective. In three studies with a control (no treatment) arm, the pooled risk ratio for symptomatic thromboembolic events with versus without antiplatelet therapy was 0.33 (95% CI 0.17 to 0.92, p= 0.035). The cumulative risk of symptomatic thromboembolic events with single antiplatelet agents was 5.0% '56/1122' (95% CI 1.6% to 8.4%, I Periprocedural antiplatelet therapy was associated with a low symptomatic thromboembolic event after coiling-only for unruptured aneurysms. However, available evidence is of limited quality with significant heterogeneity, requiring evidence from randomized controlled trials.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Thromboembolic events are recognized complications of aneurysm coiling.
OBJECTIVE
OBJECTIVE
To identify any protective effects of antiplatelet therapy use before coiling of unruptured aneurysms.
METHODS
METHODS
We conducted a meta-analysis of clinical studies published up to February 2019. We included studies reporting symptomatic thromboembolic events (defined as clinical stroke or transient ischemic attacks) in patients who received antiplatelet therapy before coiling of unruptured aneurysms using unassisted coiling, balloon assistance, or multiple microcatheters. We excluded ruptured aneurysms and those treated with stent coiling or flow diverters.
RESULTS
RESULTS
We identified 14 studies (2486 patients). All were single-center studies and four were prospective. In three studies with a control (no treatment) arm, the pooled risk ratio for symptomatic thromboembolic events with versus without antiplatelet therapy was 0.33 (95% CI 0.17 to 0.92, p= 0.035). The cumulative risk of symptomatic thromboembolic events with single antiplatelet agents was 5.0% '56/1122' (95% CI 1.6% to 8.4%, I
CONCLUSION
CONCLUSIONS
Periprocedural antiplatelet therapy was associated with a low symptomatic thromboembolic event after coiling-only for unruptured aneurysms. However, available evidence is of limited quality with significant heterogeneity, requiring evidence from randomized controlled trials.
Identifiants
pubmed: 31540948
pii: neurintsurg-2019-015173
doi: 10.1136/neurintsurg-2019-015173
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
298-302Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: MAA and MG are theprincipal investigators of a randomized controlled trial comparing acetyl salicylicacid with placebo in preventing thromboembolic complications in patients undergoing coiling-only procedures for unruptured brain aneurysms.