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

Hong, Noah; Cho, Young Dae; Kim, Hyun Sik; Pang, Chang Hwan; Yoo, Dong Hyun; Kim, Jeong Eun; Kim, Kang Min; Cho, Won Sang; Lee, Sung Ho; Kang, Hyun-Seung

doi:10.1016/j.neurad.2022.03.009

Cited by 5 publications

(12 citation statements)

References 36 publications

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“…Therefore, they also suggested that it may be safe to discontinue antiplatelet agents after SACE in patients at low risk for ischemia, and the optimal time to discontinue might be around 18-36 months after SACE. 11) The risk of cerebral infarction according to the period of DAPT use was 273 times higher (p=0.035) in patients who used DAPT for over 13 months than in other groups, which is contrary to the established fact. This group continued to use DAPT for over 13 months, which is longer than the typical period because cerebral atherosclerosis was thought to be very severe.…”

Section: Discussionmentioning

confidence: 76%

“…It is a common recommendation to maintain MAPT for the rest of one’s life after SACE. However, many researchers have questioned whether the maintenance of MAPT for a lifetime in patients undergoing SACE without vasculopathy such as atherosclerosis is a good choice, and there is an opinion that MAPT can be stopped after a certain period of time [ 7 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms

Kim¹

2023

J Cerebrovasc Endovasc Neurosurg

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Objective: Dual antiplatelet therapy (DAPT) is usually temporarily used after stent-assisted coil embolization (SACE), and is commonly converted to mono antiplatelet therapy (MAPT) for indefinitely. In this study, we aimed to find the possibility of discontinuing MAPT, and to determine the proper period of DAPT use.Methods: We used the Standard Sample Cohort DB dataset from the National Health Insurance Sharing Service. Among approximately 1 million people in the dataset, SACE was performed in 214 patients whose data this study analyzed. The relationship between discontinuation of antiplatelet therapy and intracranial hemorrhage or cerebral infarction was analyzed using multiple logistic regression, considering all confounding variables. The survival rate according to the continuation of antiplatelet therapy was obtained using Kaplan-Meier analysis, and the difference in survival rate according to the continuation of antiplatelet therapy was verified using the log-rank test. The hazard ratio according to continuation of antiplatelet therapy was obtained using the Cox proportional hazards model. The analysis was conducted by applying the same statistical method to the duration of DAPT use.Results: Among 214 patients who underwent SACE, 50, 159 and five patients continued, discontinued and did not use antiplatelet therapy (except at the time of procedure), respectively. In multiple logistic regression analysis, discontinuation of antiplatelet agents (including aspirin) and the period of DAPT use did not affect the occurrence of intracranial hemorrhage or cerebral infarction, considering various confounding factors. In the survival analysis according to the continuation of antiplatelet agents, patients who continued to use antiplatelet agents had a higher survival rate than those in other groups (p=0.00). The survival rate was higher in the rest of the group than in the group that received DAPT for three months (p=0.00).Conclusions: Continuation of antiplatelet agents or the period of DAPT use did not affect the occurrence of intracranial hemorrhage or cerebral infarction. Considering the survival rate, it would be better to maintain at least three months of antiplatelet therapy and it might be recommended to continue DAPT use for 12 months.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms

Kim¹

2023

J Cerebrovasc Endovasc Neurosurg

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“…Kim et al suggested that longer-term DAPT (>9 months) should be considered after stent-assisted coil embolization for unruptured intracranial aneurysms, although its efficacy remains to be clarified ( 10 ). Noah Hong et al ( 3 ) suggested that the optimal time to discontinue might be ~18–36 months after stent-assisted coil embolization. Large cohort-based studies or randomized clinical trials are warranted to confirm these results.…”

Section: Discussionmentioning

confidence: 99%

“…Flemming et al (1) assumed that the incidence was <0.05%, while Ince et al (2) revealed that VBD was detected in ∼2.06% of the first-ever stroke population. Patientswith VBD commonly present with ischemic stroke, intracranial hemorrhage, and compression of the brainstem and/or cranial nerves (3)(4)(5)(6)(7)(8)(9), which could lead to high rates of morbidity and mortality (10). Among endovascular treatments, stent-assisted coil embolization is one of the main treatment modalities for VBD.…”

Section: Introductionmentioning

confidence: 99%

“…However, the duration of post-procedure antiplatelet therapy remains questionable. Some studies provide recommendations for the optimal duration according to clinical experience, but there is no definite evidence of timing for the discontinuation of antiplatelet therapy ( 2 , 3 ). Thus, we present an autopsy case of late in-stent thrombosis due to the discontinuation of antiplatelet therapy and systematically review the literature.…”

Section: Introductionmentioning

confidence: 99%

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Case report: Late in-stent thrombosis in a patient with vertebrobasilar dolichoectasia after stent-assisted coil embolization due to the discontinuation of antiplatelet therapy

Yang

et al. 2023

Front. Neurol.

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Vertebrobasilar dolichoectasia (VBD) is a rare type of cerebrovascular disorder with high rates of morbidity and mortality. Due to the distinct pathological characteristics that fragmented internal elastic lamina and multiple dissections, VBD is difficult to treat and cured. Stent-assisted coil embolization is one of the main treatment modalities for such lesions. However, the duration of healing remained questionable, and there were no effective measures for evaluating endothelial coverage. Before complete endothelial coverage, the discontinuation of antiplatelet therapy may lead to fatal in-stent thrombosis; however, continued antiplatelet therapy could also result in bleeding complications. Thus, we present an autopsy case of late in-stent thrombosis due to the discontinuation of antiplatelet therapy and systematically review the literature to provide a reference for endovascular treatment and antiplatelet regimen of VBD.

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Safety and effectiveness of the LVIS and LVIS Jr devices for the treatment of intracranial aneurysms: Final results of the LEPI multicenter cohort study

Forestier,

Piotin,

Chau

et al. 2024

Journal of Neuroradiology

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

Cited by 5 publications

References 36 publications

Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms

Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms

Case report: Late in-stent thrombosis in a patient with vertebrobasilar dolichoectasia after stent-assisted coil embolization due to the discontinuation of antiplatelet therapy

Safety and effectiveness of the LVIS and LVIS Jr devices for the treatment of intracranial aneurysms: Final results of the LEPI multicenter cohort study

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