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Prophylactic administration of tirofiban for preventing thromboembolic events in flow diversion treatment of intracranial aneurysms
  1. Qiaowei Wu,
  2. Qiuji Shao,
  3. Li Li,
  4. Xiaodong Liang,
  5. Kaitao Chang,
  6. Tianxiao Li,
  7. Yingkun He
  1. Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou, China
  1. Correspondence to Dr Tianxiao Li, Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou 450000, China; dr.litianxiao{at}henu.edu.cn; Dr Yingkun He, Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital and Henan University People's Hospital, Zhengzhou 450000, China; heyingkun{at}henu.edu.cn

Abstract

Background Flow diverter (FD) is widely used in the treatment of intracranial aneurysms. However, thromboembolic events (TEs) continue to be the major complications during the periprocedural phase. To evaluate the safety and efficacy of the prophylactic use of tirofiban, combined with the conventional dual antiplatelet therapy (DAT), as a new antiplatelet protocol in patients with intracranial aneurysms treated with FDs.

Methods At least 3–5 days before the procedure, daily DAT were administrated to the patients. Tirofiban was administered as an intravenous bolus (5 µg/kg) over a 3 min period during or immediately after FD deployment, followed by a 0.05 µg/kg/min maintenance infusion for 24–48 hours. Periprocedural TEs and hemorrhagic events (HEs) were recorded.

Results A total of 331 patients were included, including 229 (69.2%) who received tirofiban administration (tirofiban group) and 102 (30.8%) who received only DAT (non-tirofiban group). Periprocedural TEs occurred in 12 (3.6%) patients, including eight (7.8%) in the non-tirofiban group and four (1.7%) in the tirofiban group. In multivariate analysis, patients receiving tirofiban administration had significantly lower TEs as compared with those who received only DAT (P=0.004). Balloon angioplasty and longer procedure time (>137 min) were also risk factors for TEs. Also, no increase was observed in the rate of HEs related to tirofiban administration.

Conclusions The current study suggested that prophylactic administration of tirofiban combined with conventional oral DAT seems safe and efficient for preventing TEs during FD treatment of unruptured intracranial aneurysms. Balloon angioplasty and prolonged procedure are associated with a high risk of TEs.

  • flow diverter
  • aneurysm
  • platelets
  • complication
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Footnotes

  • QW and QS are joint first authors.

  • QW and QS contributed equally.

  • Contributors All authors made a significant contribution to the study and manuscript preparation. QW, QS, TL, and YH contributed to study conception and design, QW, XL, KC, and LL contributed to data acquisition, data interpretation, and analysis. QW and QS drafted the manuscript. KC, TL, and YH contributed significant intellectual content. All authors critically revised the paper and approved the final version of the manuscript.

  • Funding This study was supported by grants from the National Key Research and Development Project (2016YFC1300702) and the Key scientific research projects of colleges and universities in Henan Province (21A320002).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was approved by the institutional review board of Henan Provincial People's Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Unpublished data are available upon reasonable request from the corresponding author.

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