Intravenous administration of tirofiban versus loading dose of oral clopidogrel for preventing thromboembolism in stent-assisted coiling of intracranial aneurysms.

Background: Thromboembolic complications after stenting of intracranial aneurysms may be affected by antiplatelet administration. Aims: This retrospective study aimed to assess the safety of intravenous tirofiban versus loading dose of oral clopidogrel for preventing thromboembolism in stent-assisted coiling of intracranial aneurysms. Methods: From January 2006 to December 2013, 281 patients with cerebral aneurysms were treated with stent-coiling using two antiplatelet strategies in comparison: the initial strategy (a loading dose of ≥300 mg clopidogrel followed by dual antiplatelet, clopidogrel group) and the modified strategy (intravenous administration of tirofiban 8 μg/kg over 3 min followed by a maintenance dose of 0.1 μg/kg/min for 24 h, tirofiban group). The end points were rates of perioperative thromboembolic events and intracranial hemorrhages. Results: Thromboembolic events were observed more often in the clopidogrel group (13/120 aneurysms, 10.83%) than the tirofiban group (6/178 aneurysms, 3.37%; P=0.010), with no increase in the rate of intracranial hemorrhages (P=0.164). In the ruptured subgroups, thromboembolic events were significantly fewer in the tirofiban subgroup (5/128, 3.91%) compared with the clopidogrel subgroup (7/53, 13.21%; P=0.043) with no increase in the rate of hemorrhage (P=0.360). Conclusions: Intravenous administration of tirofiban is safe in intracranial aneurysms treated with stent-assisted coiling. [ABSTRACT FROM AUTHOR]