Intracranial Hemorrhage Following Neuroendovascular Procedures with Abciximab is Associated with High Mortality: A Multicenter Series

Walsh, Ryan D.; Barrett, Kevin M.; Aguilar, Maria I.; Lanzino, Giuseppe; Hanel, Ricardó A.; Miller, David A.; Chong, Brian W.; Freeman, William D.

doi:10.1007/s12028-010-9338-1

Cited by 34 publications

(20 citation statements)

References 23 publications

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“…However, several studies reported that abciximab and eptifibatide may induce fatal intracerebral hemorrhage. 7,[14][15][16] Moreover, abciximab binds irreversibly to the glycoprotein IIb/IIIa receptor causing platelet-function suppression for almost 48 hours after interruption of the infusion. 17 Tirofiban acts as a reversible antagonist of fibrinogen by binding to the glycoprotein IIb/IIIa receptor on platelets.…”

Section: -12mentioning

confidence: 99%

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Kim¹,

Choi²,

Kang³

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Stent-assisted coiling of intracranial aneurysms requires antiplatelet therapy, typically aspirin and clopidogrel to prevent thromboembolic complications. There is a substantial concern that tirofiban may increase the risk of hemorrhage when used as an antiplatelet premedication in ruptured intracranial aneurysms. Our aim was to evaluate the safety and efficacy of intravenous tirofiban administration, instead of oral dual antiplatelet agents, as an antiplatelet premedication for stent-assisted coiling in patients with acutely ruptured intracranial aneurysms.

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Section: -12mentioning

confidence: 99%

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Kim¹,

Choi²,

Kang³

et al. 2015

AJNR Am J Neuroradiol

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“…42 Additionally, a recent multicenter series including 12 AIS patients undergoing IAT with adjunctive IV or IA abciximab resulted in sICH in 3 (25%). 43 The use of GP IIb/ IIIa inhibitors in AIS patients undergoing IAT remains investigational and of uncertain benefit.…”

Section: Antithrombotic Agents For Recanalizationmentioning

confidence: 99%

Periprocedural antithrombotic strategies in acute ischemic stroke interventional therapy

2012

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In patients undergoing endovascular therapy for acute ischemic stroke, antithrombotic therapies are utilized to prevent distal embolization, arterial reocclusion, or catheter-related embolism. However, this must be weighed against the risk of hemorrhagic complications secondary to existing and ongoing ischemia or silent vessel perforation. In this article, we present an overview of the available literature evaluating antithrombotic therapy in patients undergoing endovascular therapy for acute ischemic stroke and discuss the emerging role of these agents. Neurology ® 2012;79 (Suppl 1):S174-S181 GLOSSARY ACT ϭ activated clotting time; ADP ϭ adenosine diphosphate; AIS ϭ acute ischemic stroke; CI ϭ confidence interval; GP ϭ glycoprotein; IA ϭ intra-arterial; IAT ϭ intra-arterial therapy; IMS ϭ Interventional Management of Stroke; IU ϭ international units; MCA ϭ middle cerebral artery; MERCI ϭ Mechanical Embolus Removal in Cerebral Ischemia; OR ϭ odds ratio; PCI ϭ percutaneous coronary intervention; PROACT ϭ Prolyse in Acute Cerebral Thromboembolism; rpro-UK ϭ recombinant prourokinase; rtPA ϭ recombinant tissue plasminogen activator; sICH ϭ symptomatic intracerebral hemorrhage; TIMI ϭ thrombolysis in myocardial ischemia; UK ϭ urokinase.Intra-arterial therapy (IAT) has emerged as an important adjunct to IV thrombolysis in acute ischemic stroke (AIS). Although IAT has many theoretical advantages, including site specificity and high recanalization rates, early reocclusion and distal embolization occur in 18%-22% and 16%, respectively, of the AIS patient population that undergoes endovascular therapy. 1-3Periprocedural antithrombotic therapy may be used to reduce these complications, but it must be weighed against the risk of hemorrhagic complications. Here we present an overview of the literature evaluating the utility of antithrombotic therapies for periprocedural support and recanalization in patients undergoing AIS endovascular therapy. ANTITHROMBOTIC AGENTS FOR PERIPROCEDURAL SUPPORT Anticoagulation therapy.Since the development of percutaneous coronary intervention (PCI), IV unfractionated heparin has remained the primary antithrombotic agent for prevention of periprocedural ischemic complications as a result of its immediate anticoagulation effect, its short half-life, its ability to be monitored with point-of-care testing, and the availability of IV protamine sulfate to rapidly reverse its anticoagulation effect.4,5 Unfractionated heparin-mediated inactivation of coagulation proteases (thrombin, factors IXa, Xa, XIa, and XIIa) occurs via its binding to and subsequent activation of antithrombin III (figure 1).6 Optimal periprocedural activated clotting time (ACT) in PCI has been empirically determined to range from 250 to 350 seconds (normal, 81-125 seconds), 7 based on the American College of Cardiology level of evidence C (consensus opinion of experts, case studies, standard of care).8 Similarly, there are limited data on the safety of periprocedural heparin in AIS endovascular therapy.The Prolyse in Acu...

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“…However other researchers have identified that intra-arterial abciximab could induce fatal hemorrhage (11,16). In addition, operations such as decompressive craniectomy or external ventricular drainage are sometimes necessary after coil embolization, especially in cases of ruptured cerebral aneurysms.…”

Section: Resultsmentioning

confidence: 99%

Intra-arterial infusion of tirofiban and urokinase for thromboembolic complications during coil embolization of ruptured intracranial aneurysms

Feng¹,

Chen²,

Lv³

et al. 2014

Turkish Neurosurgery

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AIm: To investigate the effectiveness and safety of intra-arterial tirofiban and urokinase for thromboembolic complications during detachable coil treatment of ruptured intracranial aneurysms. mATERIAl and mEThods: Fourteen patients who had a thromboembolic complication during detachable coil treatment of ruptured cerebral aneurysms from May 2011 to October 2013 were enrolled in this study. Within one hour of thrombus formation, patients underwent intra-arterial infusion of tirofiban plus urokinase with digital subtraction angiography monitoring. Blood flow was checked every 5 min with angiography until complete or partial recanalization of the occluded artery occurred. REsulTs:Of the 14 patients, 10 exhibited complete recanalization immediately after the thrombolytic treatment, and had no neurological dysfunction except one patient with mild hemiplegia. Two patients with partial recanalization exhibited mild neurological dysfunction and one died of cardiac infarction during the recovery period. Two patients had intracranial hemorrhage. In one of these, this was caused by rupture of the aneurysm and the patient died during the thrombolytic treatment. In the remaining patient, intracranial hemorrhage was caused by a puncture of the left posterior internal frontal artery caused by mechanical thrombolysis.CoNClusIoN: Intra-arterial administration of tirofiban plus urokinase is an effective and safe treatment for thromboembolism during detachable coil treatment of ruptured intracranial aneurysms.

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Intracranial Hemorrhage Following Neuroendovascular Procedures with Abciximab is Associated with High Mortality: A Multicenter Series

Abstract: Adjunctive use of abciximab to prevent or treat ischemic sequelae during neuroendovascular procedures is associated with a high risk of ICH (18%). We report 9 cases of ICH associated with abciximab administration during neuroendovascular procedures with 44% mortality.

Cited by 34 publications

References 23 publications

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms

Periprocedural antithrombotic strategies in acute ischemic stroke interventional therapy

Intra-arterial infusion of tirofiban and urokinase for thromboembolic complications during coil embolization of ruptured intracranial aneurysms

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