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Vol. 29. Num. 1.January - February 2018Pages 1-56
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Vol. 29. Num. 1.January - February 2018Pages 1-56
Clinical Research
DOI: 10.1016/j.neucie.2017.08.002
Thrombotic and haemorrhagic complications in patients with cerebral aneurysms treated by endovascular approach and their association with the use of antiplatelet agents: Descriptive evaluation
Complicaciones trombóticas y hemorrágicas en pacientes con aneurismas cerebrales tratados por vía endovascular y su relación con el uso de antiagregantes plaquetarios: evaluación descriptiva
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Juan Carlos Puentesa, Silvia Tatiana Quinterob,
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silviatatianaquintero@gmail.com

Corresponding author.
, Luís Felipe Urizac, Maria Alejandra Ruedad, Adriana Piedrahitad, Victor Contrerasd
a Neurocirujano endovascular, Unidad de Neurocirugía, Departamento de Neurociencias, Hospital Universitario San Ignacio, Bogotá, Colombia
b Residente de Neurocirugía, Pontificia Universidad Javeriana, Bogotá, Colombia
c Radiólogo, magister en Epidemiologia clínica, Servicio de Radiología e Imágenes Diagnósticas, Hospital Universitario San Ignacio, Bogotá, Colombia
d Pontificia Universidad Javeriana, Bogotá, Colombia
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Tables (2)
Table 1. Results of a multivariate logistic regression analysis with respect to thrombotic complications in patients with cerebral aneurysms treated by endovascular approach during and within seven days of the procedure.
Table 2. Results of a multivariate logistic regression analysis with respect to haemorrhagic complications in patients with cerebral aneurysms treated by endovascular approach during the procedure and within the first week of follow-up.
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Abstract
Objective

The protocol for optimal antiplatelet therapy to prevent thrombotic complications following brain aneurysm embolisation is not clear. Our objective is to describe the characteristics of patients presenting with thrombotic or haemorrhagic complications secondary to endovascular treatment.

Methods

A cross sectional descriptive study was performed, which included all patients that required endovascular treatment for brain aneurysm at San Ignacio University Hospital from November 2007 to January 2016. Thrombotic and haemorrhagic complications over six months of follow-up were assessed, considering the premedication regimen with antiplatelet agents, location, size of the aneurysm and embolisation technique performed.

Results

122 patients were evaluated, on whom 130 procedures were performed for endovascular treatment of brain aneurysms. Thrombotic complications were more frequent in patients who did not receive premedication (25%) compared to those who did receive an antiplatelet treatment regimen (standard dose 3.87% or loading dose 8.70%), and this difference was statistically significant (p=0.043).

Conclusions

Thromboembolic events are the most common complication of brain aneurysm embolisation. Both our study and the literature suggest that the use of dual antiplatelet therapy with aspirin and clopidogrel lowers the rate of symptomatic thromboembolic complications, regardless of the administration protocol.

Keywords:
Antiplatelet therapy
Cerebral aneurysm
Endovascular treatment
Intracerebral haemorrhage
Cerebral infarction
Resumen
Objetivo

El protocolo de medicación antiplaquetaria óptimo para prevenir las complicaciones trombóticas después de embolización de aneurismas cerebrales no es claro. Nuestro objetivo es describir las características de los pacientes que presentan complicaciones trombóticas o hemorrágicas secundarias al tratamiento endovascular.

Métodos

Se realizó un estudio descriptivo de corte transversal. Se incluyó a todos los pacientes que requirieron manejo endovascular de aneurismas cerebrales en el Hospital Universitario San Ignacio desde noviembre del 2007 hasta enero del 2016. Se evaluaron las complicaciones trombóticas o hemorrágicas durante 6 meses de seguimiento, teniendo en cuenta el esquema de premedicación con antiagregantes plaquetarios, localización, tamaño del aneurisma y técnica de embolización utilizada.

Resultados

Se evaluó a 122 pacientes en los cuales se realizaron 130 procedimientos para tratamiento endovascular de aneurismas cerebrales. Las complicaciones trombóticas fueron más frecuentes en pacientes que no recibieron premedicación (25%) comparados con aquellos que recibieron algún esquema de antiagregación (estándar 3,87% o carga 8,70%); esta diferencia fue estadísticamente significativa (p=0,043).

Conclusiones

Los eventos tromboembólicos son la complicación más frecuente de la embolización de aneurismas cerebrales. Nuestro trabajo, al igual que la literatura revisada, sustenta el uso de terapia antiplaquetaria dual con ácido acetilsalicílico y clopidogrel para disminuir la tasa de complicaciones tromboembólicas sintomáticas independientemente del protocolo de administración.

Palabras clave:
Tratamiento antiplaquetario
Aneurismas cerebrales
Tratamiento endovascular
Hemorragia intracerebral
Infarto cerebral

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