Antiplatelet Therapy in Endovascular Treatment
Antiplatelet Therapy in Endovascular Treatment of Cerebral Aneurysm
Antiplatelet Therapy in Flow Diversion
Antiplatelet and antithrombotic medication management before, during, and after endovascular treatment has significant practice variation.
Antiplatelet Therapy in Flow Diversion.
Antiplatelet therapy is common and complicates the operative management of acute intracranial hemorrhage. Little data exist to guide antiplatelet reversal strategies.
An online survey detailing antiplatelet reversal strategies in patients presenting with acute operative intracranial hemorrhage (subdural hematoma (SDH), epidural hematoma (EDH), and intracerebral hemorrhage (ICH) was distributed to board certified neurosurgeons in the North America.
Of the 2,782 functional email addresses, there were 493 (17.7%) responses to question #1 and 429 (15.4%) completed surveys. Most respondents chose to perform no additional laboratory testing prior to surgical intervention, regardless of hemorrhage type. The most common antiplatelet reversal strategy in the presence of aspirin was platelet transfusion (SDH and ICH) or no intervention (EDH). The most common antiplatelet reversal strategy in the presence of an Adenosine diphosphate receptor inhibitor or DAPT was platelet transfusion or platelet transfusion with DDAVP administration. There was a statistically significant difference in management strategy depending on the antiplatelet therapy (p < 0.001).
When patients on antiplatelet medication present with operative intracranial hemorrhage, the majority of neurosurgeons do not perform qualitative platelet testing. Antiplatelet reversal strategies are significantly influenced by the antiplatelet therapy with more aggressive reversal strategies employed in the presence of ADP antagonists 1).