A Clinical Study Of TEG In Guiding Antiplatelet Therapy After Stent-assisted Embolization Of Intracranial Aneurysms

Objective: To preliminarily explore the single-center experience of using thromboelastography(TEG)to guide perioperative antiplatelet therapy in patients treated with stent-assisted coiling of intracranial aneurysms.Methods: The clinical data of 240 patients with intracranial aneurysms treated with stent-assisted coiling of intracranial aneurysms were retrospectively analyzed from January 2013 to December 2019 in the Neurosurgery Department of the First Affiliated Hospital of Chongqing Medical University.Patients were divided into standard group(58 cases)and adjustment group(182 cases)according to whether TEG testing was performed.Patients in the standard group were treated with aspirin 100 mg and clopidogrel 75 mg after surgery.Patients in the adjustment group were treated with an antiplatelet regimen adjusted based on TEG parameters.The frequency of bleeding or ischemic events during antiplatelet therapy,the prognostic score of GOS(Glasgow Outcome Scale)at discharge between both groups,and the distribution of TEG parameters of patients in the adjusted group were analyzed.Results: The age,gender,Hunt-Hess grades at admission,history of smoking,drinking,diabetes,essential hypertension,operation time,whether it is a ruptured aneurysm,location and size of IA,whether it is multiple aneurysms,and the type of stent implanted were not statistically significant between both groups.(all P>0.05).The incidence of bleeding events in the adjustment group was 0.5%(1/182),which was statistically lower than 6.9%(4/58)in the standard group(P<0.05).The incidence of ischemic events in the adjustment group was 23.6%(43/182),compared with 20.6%(12/58)in the standard group,the difference was not statistically significant(P>0.05).The GOS of the two groups were all grade V at discharge.In the adjustment group,there were no statistically significant differences in the AA inhibition rate,ADP inhibition rate,and MA-ADP distribution between patients with ischemic events and those who did not(all P>0.05).Conclusion: Preliminary observations have found that TEG parameters may help identify patients with a higher risk of bleeding after stent-assisted coiling of intracranial aneurysms,and then guide antiplatelet therapy individually.Background and purpose: Stent-assisted coiling of intracranial aneurysms is usually treated with antiplatelet therapy to reduce the risk of postoperative ischemic events.However,using the same antiplatelet therapy for all patients may increase the risk of bleeding in patients with aneurysmal subarachnoid hemorrhage(a SAH).Thromboelastography(TEG)measures platelet function,which reflects the effect of antiplatelet drugs.This study aimed to evaluate the benefits of individualized antiplatelet regimens based on TEG parameters for patients with a SAH who underwent stent-assisted coilingMethods: We retrospectively included patients with a SAH who treated with stent-assisted coiling during the period from June 2012 to December 2019.Patients were divided into 2 groups: patients whose antiplatelet therapy adjusted by TEG parameters after surgery(adjustment group)and patients who treated with standard dual antiplatelet therapy without TEG test(control group).The occurrence of major/minor bleeding events,major/minor thromboembolic events,and favorable outcome(modified Rankin scale < 3)were compared in both groups during hospitalization.The patients in the adjustment group were followed up to analyze and compare the incidence of major bleeding,major thromboembolic events,and the long-term good prognosis(m RS <3)of the patients in the adjustment group who received different antiplatelet therapy.Results: Of 188 a SAH patients considered for this study,145 met the criteria for inclusion and were included in the analysis(93 patients in the adjustment group and 52 patients in the control group).The risks of minor bleeding events(1.1% vs 9.6%,p = 0.02)were significantly lower in patients in the adjustment group.But there was no significant difference in the rate of major bleeding events at discharge between adjustment and control groups(p = 0.35).The rates of thromboembolic events and favorable outcome were similar in both groups(22.6% vs 28.8%,p = 0.42,95.7% vs 96.2%,p = 1.00).Furthermore,the minor thromboembolic events rate was significantly lower in the patients treated with treatment plan C(P=0.02 for treatment plan C versus treatment A,P= 0.03 for treatment plan C versus treatment plan B).But there was no significant difference in the rate of other mentioned above complications and favorable outcomes among patients treated with different antiplatelet regimens.Conclusions: Individualized antiplatelet therapy based on TEG parameters might positively impact the bleeding risk of a SAH patients,without significantly increasing the risk for clinically relevant thromboembolic events.