Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: Association with reduced risk of clinical vasospasm and delayed cerebral ischemia

Yasunori Nagahama, Lauren Allan, Daichi Nakagawa, Mario Zanaty, Robert M. Starke, Nohra Chalouhi, Pascal Jabbour, Robert D Jr. Brown, Colin P. Derdeyn, Enrique C. Leira, Joseph Broderick, Marc Chimowitz, James C. Torner, David Hasan

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients. METHODS Analysis of patients treated for aSAH during the period from July 2009 to April 2014 was performed in a single-institution retrospective study. Patients were divided into 2 groups: patients who underwent stent-assisted coiling or placement of flow diverters requiring DAPT (DAPT group) and patients who underwent coiling only without DAPT (control group). The frequency of symptomatic clinical vasospasm and DCI and of hemorrhagic complications was compared between the 2 groups, utilizing univariate and multivariate logistic regression. RESULTS Of 312 aSAH patients considered for this study, 161 met the criteria for inclusion and were included in the analysis (85 patients in the DAPT group and 76 patients in the control group). The risks of clinical vasospasm (OR 0.244, CI 95% 0.097-0.615, p = 0.003) and DCI (OR 0.056, CI 95% 0.01-0.318, p = 0.001) were significantly lower in patients receiving DAPT. The rates of hemorrhagic complications associated with placement of external ventricular drains and ventriculoperitoneal shunts were similar in both groups (4% vs 2%, p = 0.9). CONCLUSIONS The use of DAPT was associated with a lower risk of clinical vasospasm and DCI in patients treated for aSAH, without an increased risk of hemorrhagic complications.

Original languageEnglish (US)
Pages (from-to)702-710
Number of pages9
JournalJournal of Neurosurgery
Volume129
Issue number3
DOIs
StatePublished - Sep 1 2018

Fingerprint

Subarachnoid Hemorrhage
Brain Ischemia
Therapeutics
clopidogrel
Ventriculoperitoneal Shunt
Control Groups
Platelet Activation
Aspirin
Stents
Retrospective Studies
Logistic Models

Keywords

  • Aneurysm rupture
  • Aspirin
  • Clopidogrel
  • Coil
  • Stent
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage : Association with reduced risk of clinical vasospasm and delayed cerebral ischemia. / Nagahama, Yasunori; Allan, Lauren; Nakagawa, Daichi; Zanaty, Mario; Starke, Robert M.; Chalouhi, Nohra; Jabbour, Pascal; Brown, Robert D Jr.; Derdeyn, Colin P.; Leira, Enrique C.; Broderick, Joseph; Chimowitz, Marc; Torner, James C.; Hasan, David.

In: Journal of Neurosurgery, Vol. 129, No. 3, 01.09.2018, p. 702-710.

Research output: Contribution to journalArticle

Nagahama, Y, Allan, L, Nakagawa, D, Zanaty, M, Starke, RM, Chalouhi, N, Jabbour, P, Brown, RDJ, Derdeyn, CP, Leira, EC, Broderick, J, Chimowitz, M, Torner, JC & Hasan, D 2018, 'Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: Association with reduced risk of clinical vasospasm and delayed cerebral ischemia', Journal of Neurosurgery, vol. 129, no. 3, pp. 702-710. https://doi.org/10.3171/2017.5.JNS17831
Nagahama, Yasunori ; Allan, Lauren ; Nakagawa, Daichi ; Zanaty, Mario ; Starke, Robert M. ; Chalouhi, Nohra ; Jabbour, Pascal ; Brown, Robert D Jr. ; Derdeyn, Colin P. ; Leira, Enrique C. ; Broderick, Joseph ; Chimowitz, Marc ; Torner, James C. ; Hasan, David. / Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage : Association with reduced risk of clinical vasospasm and delayed cerebral ischemia. In: Journal of Neurosurgery. 2018 ; Vol. 129, No. 3. pp. 702-710.
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abstract = "OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients. METHODS Analysis of patients treated for aSAH during the period from July 2009 to April 2014 was performed in a single-institution retrospective study. Patients were divided into 2 groups: patients who underwent stent-assisted coiling or placement of flow diverters requiring DAPT (DAPT group) and patients who underwent coiling only without DAPT (control group). The frequency of symptomatic clinical vasospasm and DCI and of hemorrhagic complications was compared between the 2 groups, utilizing univariate and multivariate logistic regression. RESULTS Of 312 aSAH patients considered for this study, 161 met the criteria for inclusion and were included in the analysis (85 patients in the DAPT group and 76 patients in the control group). The risks of clinical vasospasm (OR 0.244, CI 95{\%} 0.097-0.615, p = 0.003) and DCI (OR 0.056, CI 95{\%} 0.01-0.318, p = 0.001) were significantly lower in patients receiving DAPT. The rates of hemorrhagic complications associated with placement of external ventricular drains and ventriculoperitoneal shunts were similar in both groups (4{\%} vs 2{\%}, p = 0.9). CONCLUSIONS The use of DAPT was associated with a lower risk of clinical vasospasm and DCI in patients treated for aSAH, without an increased risk of hemorrhagic complications.",
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T1 - Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage

T2 - Association with reduced risk of clinical vasospasm and delayed cerebral ischemia

AU - Nagahama, Yasunori

AU - Allan, Lauren

AU - Nakagawa, Daichi

AU - Zanaty, Mario

AU - Starke, Robert M.

AU - Chalouhi, Nohra

AU - Jabbour, Pascal

AU - Brown, Robert D Jr.

AU - Derdeyn, Colin P.

AU - Leira, Enrique C.

AU - Broderick, Joseph

AU - Chimowitz, Marc

AU - Torner, James C.

AU - Hasan, David

PY - 2018/9/1

Y1 - 2018/9/1

N2 - OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients. METHODS Analysis of patients treated for aSAH during the period from July 2009 to April 2014 was performed in a single-institution retrospective study. Patients were divided into 2 groups: patients who underwent stent-assisted coiling or placement of flow diverters requiring DAPT (DAPT group) and patients who underwent coiling only without DAPT (control group). The frequency of symptomatic clinical vasospasm and DCI and of hemorrhagic complications was compared between the 2 groups, utilizing univariate and multivariate logistic regression. RESULTS Of 312 aSAH patients considered for this study, 161 met the criteria for inclusion and were included in the analysis (85 patients in the DAPT group and 76 patients in the control group). The risks of clinical vasospasm (OR 0.244, CI 95% 0.097-0.615, p = 0.003) and DCI (OR 0.056, CI 95% 0.01-0.318, p = 0.001) were significantly lower in patients receiving DAPT. The rates of hemorrhagic complications associated with placement of external ventricular drains and ventriculoperitoneal shunts were similar in both groups (4% vs 2%, p = 0.9). CONCLUSIONS The use of DAPT was associated with a lower risk of clinical vasospasm and DCI in patients treated for aSAH, without an increased risk of hemorrhagic complications.

AB - OBJECTIVE Clinical vasospasm and delayed cerebral ischemia (DCI) are devastating complications of aneurysmal subarachnoid hemorrhage (aSAH). Several theories involving platelet activation have been postulated as potential explanations of the development of clinical vasospasm and DCI. However, the effects of dual antiplatelet therapy (DAPT; aspirin and clopidogrel) on clinical vasospasm and DCI have not been previously investigated. The objective of this study was to evaluate the effects of DAPT on clinical vasospasm and DCI in aSAH patients. METHODS Analysis of patients treated for aSAH during the period from July 2009 to April 2014 was performed in a single-institution retrospective study. Patients were divided into 2 groups: patients who underwent stent-assisted coiling or placement of flow diverters requiring DAPT (DAPT group) and patients who underwent coiling only without DAPT (control group). The frequency of symptomatic clinical vasospasm and DCI and of hemorrhagic complications was compared between the 2 groups, utilizing univariate and multivariate logistic regression. RESULTS Of 312 aSAH patients considered for this study, 161 met the criteria for inclusion and were included in the analysis (85 patients in the DAPT group and 76 patients in the control group). The risks of clinical vasospasm (OR 0.244, CI 95% 0.097-0.615, p = 0.003) and DCI (OR 0.056, CI 95% 0.01-0.318, p = 0.001) were significantly lower in patients receiving DAPT. The rates of hemorrhagic complications associated with placement of external ventricular drains and ventriculoperitoneal shunts were similar in both groups (4% vs 2%, p = 0.9). CONCLUSIONS The use of DAPT was associated with a lower risk of clinical vasospasm and DCI in patients treated for aSAH, without an increased risk of hemorrhagic complications.

KW - Aneurysm rupture

KW - Aspirin

KW - Clopidogrel

KW - Coil

KW - Stent

KW - Vascular disorders

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