Effect of Antiplatelet Therapy for Endovascular Coiling in Aneurysmal Subarachnoid Hemorrhage

• Published in: Stroke (1970) Vol. 40; no. 6; pp. 1969 - 1972
• Main Authors: VAN DEN BERGH, Walter M, KERR, Richard S. C, ALGRA, Ale, RINKEL, Gabriel J. E, MOLYNEUX, Andrew J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.06.2009
• Subjects: Aspirin - therapeutic use; Biological and medical sciences; Data Collection; Diseases of the nervous system; Female; Humans; Intraoperative Complications - blood; Intraoperative Complications - prevention & control; Male; Medical sciences; Middle Aged; Neurology; Neurosurgical Procedures; Platelet Aggregation Inhibitors - therapeutic use; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk; Stents; Subarachnoid Hemorrhage - blood; Subarachnoid Hemorrhage - surgery; Surgical Instruments; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vascular Surgical Procedures; Stroke; Nervous system diseases; Subarachnoid hemorrhage; Aneurysm; Cardiovascular disease; Endovascular route; endovascular treatment; Cerebral disorder; Vascular disease; Treatment; antiplatelet drugs; Central nervous system disease; Cerebrovascular disease; aneurysms
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.108.528802

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. 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. 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. The results of this study do not support the assumption that antiplatelets during or after endovascular coiling improve outcome in patients with SAH.