Article Text

Download PDFPDF
Original research
Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey
  1. Jildaz Caroff1,
  2. Laurent Aubert2,
  3. Cécile Lavenu-Bombled3,
  4. Samy Figueiredo2,
  5. Kamelia Habchi2,
  6. Jonathan Cortese1,
  7. Francois Eugene4,
  8. Julien Ognard5,
  9. Florence Tahon6,
  10. Géraud Forestier7,
  11. Heloise Ifergan8,
  12. François Zhu9,10,
  13. Jean-Francois Hak11,
  14. Anthony Reyre11,
  15. Morgane Laubacher10,
  16. Abdoulaye Traore12,
  17. Jean Philippe Desilles13,
  18. Imad Derraz14,
  19. Ricardo Moreno15,
  20. Marc Bintner16,
  21. Guillaume Charbonnier17,
  22. Anthony Le Bras18,
  23. Louis Veunac19,
  24. Florent Gariel20,
  25. Hocine Redjem21,
  26. Jacques Sedat22,
  27. Guillaume Tessier23,
  28. Victor Dumas24,
  29. Maxime Gauberti25,
  30. Cyril Chivot26,
  31. Arturo Consoli27,
  32. Nicolas Bricout28,
  33. Titien Tuilier29,
  34. Alexis Guedon30,
  35. Raoul Pop31,
  36. Pierre Thouant32,
  37. Guillaume Bellanger33,
  38. Riccardo Zannoni34,
  39. Sebastien Soize35,
  40. Johann Sebastian Richter36,
  41. Olivier Heck37,
  42. Cristian Mihalea1,
  43. Julien Burel38,
  44. Jean-Baptiste Girot39,
  45. Eimad Shotar40,
  46. Sebastian Gazzola41,
  47. Gregoire Boulouis42,
  48. Basile Kerleroux43
  49. JENI Research Collaboration
    1. 1Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
    2. 2Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
    3. 3Department of Biological Hematology, Assistance Publique-Hôpitaux de Paris, Faculté de médecine Paris Saclay, Hospital Bicetre, Le Kremlin-Bicetre, France
    4. 4Department of Radiology, CHU Rennes, Rennes, France
    5. 5Department of Neuroradiology, CHU Brest, Brest, France
    6. 6Department of Neuroradiology, Hôpital Privé Clairval, Marseille, France
    7. 7Department of Neuroradiology, CHU Limoges, Limoges, France
    8. 8Diagnostic and Interventional Neuroradiology, CHU Tours, Tours, France
    9. 9Department of Diagnostic and Interventional Neuroradiology, CHU Nancy, Nancy, France
    10. 10Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
    11. 11Department of Neuroradiology, Hospital Timone, Marseille, France
    12. 12Department of Neuroradiology, Hôpital Louis Pasteur, Colmar, France
    13. 13Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France
    14. 14Department of Neuroradiology, CHU Montpellier, Montpellier, France
    15. 15Department of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
    16. 16Department of Neuroradiology, CHU de la Réunion, Saint-Denis, France
    17. 17Department of Neuroradiology, CHU Besançon, Besançon, France
    18. 18Department of Radiology, CH Bretagne Atlantique Site Chubert, Vannes, France
    19. 19Department of Radiology, CH de la Cote Basque, Bayonne, France
    20. 20Department of Interventional Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
    21. 21Department of Interventional Neuroradiology, Clinique des Cèdres, Toulouse, France
    22. 22Department of Interventional Neuroradiology, CHU Nice, Nice, France
    23. 23Department of Neuroradiology, CHU Nantes, Nantes, France
    24. 24Department of Radiology, CHU Poitiers, Poitiers, France
    25. 25Department of Neuroradiology, CHU Caen, Caen, France
    26. 26Department of Neuroradiology, CHU Amiens-Picardie, Amiens, Hauts-de-France, France
    27. 27Department of Neuroradiology, Hospital Foch, Suresnes, France
    28. 28Department of Interventional Neuroradiology, CHU Lille, Lille, France
    29. 29Department of Neuroradiology, CHU Henri Mondor, Créteil, France
    30. 30Department of Neuroradiology, CHU Lariboisiere Fernand-Widal, Paris, France
    31. 31Department of Neuroradiology, CHU Strasbourg, Strasbourg, France
    32. 32Department of Neuroradiology, CHU Dijon, Dijon, France
    33. 33Department of Neuroradiology, CHU Toulouse, Toulouse, France
    34. 34Department of Neuroradiology, CHU Saint-Etienne, Saint-Etienne, France
    35. 35Department of Neuroradiology, CHU Reims, Reims, France
    36. 36Department of Radiology, CH Pau, Pau, France
    37. 37Department of Neuroradiology, CHU Grenoble, Grenoble, France
    38. 38Department of Radiology, CHU Rouen, Rouen, France
    39. 39Department of Radiology, CHU Angers, Angers, France
    40. 40Department of Neuroradiology, CHU Pitié Salpêtrière, Paris, France
    41. 41Department of Neuroradiology, Saint Anne Military Hospital, Toulon, France
    42. 42Department of Neuroradiology, CHU Tours, Tours, France
    43. 43Department of Neuroradiologie, Saint Anne Hospital, Paris, France
    1. Correspondence to Dr Jildaz Caroff, Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France; jildaz.caroff{at}aphp.fr

    Abstract

    Background Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.

    Methods In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).

    Results All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.

    Conclusion This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.

    • Drug
    • Intervention
    • Pharmacology
    • Platelets
    • Standards

    Data availability statement

    Data are available upon reasonable request.

    Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request.

    View Full Text

    Footnotes

    • Twitter @jildazz, @gcharbonnier, @GuillaumeTess12, @dumasvictor2, @RaoulPop25, @CRISTIANMIHALEA, @gboulouis

    • Collaborators JENI Research Collaboration : Julien Boucherit, Gaultier Marnat, Mourad Cheddad El Aouni, Federico Bolognini, Pierre-Olivier Comby, Martin Bretzner, Riyad Hanafi, Maxime Drai, Benoit Testud, Cyril Dargazanli, Liang Liao, Wagih Ben Hassen, Julien Allard, François Delvoye, Pierre-François Manceau, Quentin Alias, Margaux Lefebvre, Dan Sorin Mihoc, Jean Darcourt, Kevin Janot, Vincent L'Allinec, Jean Papaxanthos and Vanessa Chalumeau. Other collaborators : Jacques Duranteau and Laurent Spelle.

    • Contributors JC, LA, and SF contributed to conception and design of the study. JC contributed to data collection and analysis and drafting the manuscript. SF, CLB, GB, and BK contributed to revising the manuscript for important intellectual content. All authors approved the final version to be published. JC is the guarantor of the overall content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.