Jang Hun Kim1, Jong-Il Choi2. 1. Trauma Center, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea. 2. Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea. Electronic address: thlthd@korea.ac.kr.
Abstract
OBJECTIVE: Ventriculoperitoneal shunt (VPS) surgery is sometimes necessary in patients who present with symptomatic hydrocephalus after undergoing stent-assisted coil embolization of ruptured intracranial aneurysms. However, there are no guidelines for the perioperative management of VPS using dual antiplatelet therapy (DAPT) and balancing between the thromboembolic and hemorrhagic complications. Studies regarding discontinuation of DAPT and its substitution with a less potent drug for reducing the risk of hemorrhage have been previously attempted; however, the sample size in these studies was small. This study investigates the safety and feasibility of ibuprofen bridging therapy with discontinuation of DAPT for five days in patients who have recently received a neurovascular stent and require VPS. METHODS: Forty-one patients, who were administered DAPT after neurovascular stent placement and later underwent VPS, were retrospectively enrolled. Patients were divided into two groups based on the perioperative DAPT therapy: (1) Bridge: discontinuing DAPT and substituting it with ibuprofen 600 mg bid for five days, and (2) Continue: maintaining DAPT during surgery. The groups were compared and risk factors for hemorrhagic complication were investigated. RESULTS: On comparison analysis, no ischemic complications were observed in both groups; however, hemorrhagic complications were significantly higher in the continue than in the bridge group (p = 0.004). On multivariate logistic regression analysis, "ibuprofen bridging" was identified as a significant factor negatively associated with hemorrhagic complications (p = 0.019). CONCLUSION: "Ibuprofen bridging therapy with discontinuation of DAPT for 5 days" is a potential treatment strategy for patients having recently undergone neurovascular stent placement and are scheduled for VPS surgery.
OBJECTIVE: Ventriculoperitoneal shunt (VPS) surgery is sometimes necessary in patients who present with symptomatic hydrocephalus after undergoing stent-assisted coil embolization of ruptured intracranial aneurysms. However, there are no guidelines for the perioperative management of VPS using dual antiplatelet therapy (DAPT) and balancing between the thromboembolic and hemorrhagic complications. Studies regarding discontinuation of DAPT and its substitution with a less potent drug for reducing the risk of hemorrhage have been previously attempted; however, the sample size in these studies was small. This study investigates the safety and feasibility of ibuprofen bridging therapy with discontinuation of DAPT for five days in patients who have recently received a neurovascular stent and require VPS. METHODS: Forty-one patients, who were administered DAPT after neurovascular stent placement and later underwent VPS, were retrospectively enrolled. Patients were divided into two groups based on the perioperative DAPT therapy: (1) Bridge: discontinuing DAPT and substituting it with ibuprofen 600 mg bid for five days, and (2) Continue: maintaining DAPT during surgery. The groups were compared and risk factors for hemorrhagic complication were investigated. RESULTS: On comparison analysis, no ischemic complications were observed in both groups; however, hemorrhagic complications were significantly higher in the continue than in the bridge group (p = 0.004). On multivariate logistic regression analysis, "ibuprofen bridging" was identified as a significant factor negatively associated with hemorrhagic complications (p = 0.019). CONCLUSION: "Ibuprofen bridging therapy with discontinuation of DAPT for 5 days" is a potential treatment strategy for patients having recently undergone neurovascular stent placement and are scheduled for VPS surgery.