A New Protocol for Anticoagulation With Tirofiban During Flow Diversion

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Flow diversion is a common treatment for intracranial aneurysms.
• Traditional protocols involve pretreatment with aspirin and clopidogrel to prevent complications.
• A novel anticoagulation strategy using tirofiban is being investigated.

Purpose of the Study:

• To evaluate the safety and efficacy of a new anticoagulation protocol using tirofiban during flow diversion procedures.
• To compare this protocol with traditional aspirin and clopidogrel pretreatment.

Main Methods:

• A cohort of 46 patients undergoing flow diversion were treated with intraoperative tirofiban infusion without a loading dose.
• Aspirin and clopidogrel were administered intraoperatively or just before the procedure, without prior pretreatment.
• Thromboembolic and hemorrhagic complications were meticulously recorded.

Main Results:

• The protocol demonstrated a low complication rate, with only 2 events (1 thromboembolic, 1 hemorrhagic) out of 46 patients.
• No instances of thrombocytopenia or major bleeding were observed.
• A high rate of favorable outcomes was noted, with 95.7% of patients achieving a modified Rankin Scale score of 0 to 2.

Conclusions:

• The tirofiban-based anticoagulation protocol during flow diversion is safe and effective.
• This approach serves as a viable alternative to pretreatment with dual antiplatelet therapy.
• The protocol is particularly beneficial for patients with ruptured aneurysms or when unexpected stent use occurs.