Reduced hemorrhagic complications of intravenous glycoprotein IIb/IIIa inhibitors in flow diversion for ruptured aneurysms: A single-center study and meta-analysis

Abstract

Background

Flow diversion (FD) is increasingly used to treat ruptured intracranial aneurysms (rIA); however, antiplatelet (AP) management remains controversial. Intravenous (IV) GPIIb/IIIa inhibitors provide rapid, reversible platelet inhibition and may reduce hemorrhagic risk. We performed a meta-analysis and reported our institutional series to compare IV GPIIb/IIIa and classic AP protocols in FD for rIA.

Methods

A systematic search identified studies reporting ischemic and hemorrhagic complications after FD for rIA stratified by AP regimen. Meta-analyses estimated pooled event rates and meta-regression compared outcomes between GPIIb/IIIa and classic AP strategies. We retrospectively reviewed rIA patients treated with FD at our institution.

Results

Twenty-six studies were included (387 patients): 167 (43.1%) received GPIIb/IIIa-only protocols and 220 (56.9%) received classic AP (predominantly aspirin and clopidogrel). The hemorrhagic complication rate was 9% (confidence interval (CI): 6%–13%), 5% (CI: 2%–10%) in the GPIIb/IIIa patients, and 12% (CI: 8%–17%) in the classic AP group; meta-regression demonstrated a lower hemorrhagic rate with GPIIb/IIIa (p = 0.047). The ischemic complication rate was 13% (CI: 9–19%), 11% (CI: 6–18%) in the GPIIb/IIIa group, and 15% (CI: 9%–24%) in the classic AP group (p = 0.38). Our cohort included seven patients (mean age: 59.1). Six received intra-procedural tirofiban, and one received ticagrelor/aspirin. Hemorrhagic and ischemic complications each occurred in 1/7 (14.3%) patients, two (28.6%) died and four (57.1%) achieved modified Rankin Scale ≤ 2 at 90 days.

Conclusions

IV GPIIb/IIIa inhibitors administered at FD deployment for rIA are associated with fewer hemorrhagic complications without increased ischemic events and represent a feasible acute management strategy.