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Is it safe to discontinue antiplatelet medication after stent-assisted coil embolization? If so, when is the best time? - 08/04/22

Doi : 10.1016/j.neurad.2022.03.009 
Noah Hong a, Young Dae Cho b, , Hyun Sik Kim b, Chang Hwan Pang a, Dong Hyun Yoo b, Jeong Eun Kim a, Kang Min Kim a, Won-Sang Cho a, Sung Ho Lee a, Hyun-Seung Kang a
a Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea 
b Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea 

Corresponding author at: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.Department of RadiologySeoul National University Hospital101 Daehak-roJongno-guSeoul110-744Korea
En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 08 April 2022

Abstract

Purpose

Antiplatelet maintenance after stent-assisted coil embolization (SACE) is generally considered essential to avoid post-procedural thromboembolic complications. However, there is still debate as to whether it is safe to discontinue antiplatelet drugs after SACE or when is the best time to do so. We investigate herein the clinical outcomes experienced by patients who discontinue antiplatelet agents after SACE.

Methods

From a prospective database, we retrieved the data for 120 consecutive patients (harboring 130 aneurysms) in whom antiplatelet agents were discontinued after SACE between January 2010 and December 2019. We defined thromboembolic complications associated with discontinuation as neurologic or radiographic ischemia that occurred within 6 months of discontinuation of antiplatelet agents; the lesion was required to be correlated with the stented artery.

Results

The mean time of discontinuation of antiplatelet medication was 31.4 ± 18.3 months after SACE (median, 26 months). The majority of patients stopped antiplatelet medication between 18 and 36 months after SACE (74 patients, 61.6%). Laser-cut closed-cell stent was most commonly applied in 91 aneurysms (70.0%), followed by braided closed-cell (n=29; 22.3 %) and laser-cut open-cell stent 10 (7.7 %). No patients experienced cerebral ischemia related to discontinuation of antiplatelet medication.

Conclusion

Our preliminary study suggests that it may be safe to discontinue antiplatelet medication after SACE in patients at low risk for ischemia. The optimal time to discontinue might be around 18 to 36 months after SACE. Large cohort-based studies or randomized clinical trials are warranted to confirm these results.

El texto completo de este artículo está disponible en PDF.

Graphical Abstract




Image, graphical abstract

El texto completo de este artículo está disponible en PDF.

Highlights

There is still debate as to whether it is safe to discontinue antiplatelet drugs after SACE or when is the best time to do so.
In this study, no patients experienced cerebral ischemia related to discontinuation of antiplatelet medication.
Our preliminary study suggests that it may be safe to discontinue antiplatelet medication after SACE in patients at low risk for ischemia.
The optimal time to discontinue might be around 18 to 36 months after SACE.

El texto completo de este artículo está disponible en PDF.

Keywords : Aneurysm, Coil, Embolization, Stent, Antiplatelet, Medication

Abbreviations : SACE, DAPT, SAPT


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© 2022  Elsevier Masson SAS. Reservados todos los derechos.
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