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A Systematic Review and Meta-Analysis on the Safety of Antiplatelet Discontinuation Following Stent-Assisted Coil
Mohammed Maan Al-Salihi1, Maryam Sabah Al-Jebur2, Ahmed Abd Elazim3
1Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, MO 65211, USA.
Insights
Discontinuing antiplatelet therapy after stent-assisted coil embolization (SACE) for brain aneurysms carries a low risk of thromboembolic complications. Further research is needed to determine optimal antiplatelet durations to balance risks.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Interventional Radiology
Background:
- Stent-assisted coil embolization (SACE) is a prevalent endovascular method for treating intracranial aneurysms.
- Post-SACE management requires antiplatelet therapy due to the permanent stent presence.
- Optimal duration of antiplatelet therapy post-SACE remains a clinical question.
Purpose of the Study:
- To systematically review and quantify the risk of ischemic complications following antiplatelet therapy discontinuation after SACE.
- To analyze existing literature for evidence on thromboembolic events post-SACE antiplatelet cessation.
Main Methods:
- Systematic literature search of PubMed, Cochrane Library, Scopus, and Web of Science (WOS).
- Inclusion of five observational cohort studies with data from 18,425 cases (2009-2020).
- Meta-analysis using a random-effects model to calculate the pooled event rate of ischemic complications.
Main Results:
- The pooled rate of thromboembolism within 6 to 24 months after antiplatelet discontinuation was 0.01 (95% CI: 0.006 to 0.018).
- Included studies predominantly originated from Korea and Japan.
- Follow-up duration in most studies exceeded 24 months post-discontinuation.
Conclusions:
- The risk of thromboembolic complications after discontinuing antiplatelet therapy post-SACE is low.
- A definitive consensus on the ideal duration for dual- or single-antiplatelet therapy is lacking.
- Prospective studies are necessary to establish optimal antiplatelet durations balancing thromboembolic and hemorrhagic risks.
Background:
Stent-assisted coil embolization (SACE) is a common endovascular technique for managing intracranial aneurysms. The permanent presence of a stent inside the cerebral artery necessitates the postoperative use of antiplatelets. However, a consensus about how long to continue on it remains debated. This systematic review aims to discuss and quantify the risk of ischemic complications after antiplatelet discontinuation following SACE.
Methods:
PubMed, Cochrane Library, Scopus, and Web of Science (WOS) were systematically searched for studies assessing the outcomes after antiplatelet discontinuation following SACE for cerebral aneurysms. The primary outcome was the odds of ischemic complications after antiplatelet discontinuation. Using a random-effects model, the pooled event rate, along with a 95% confidence interval (CI), was calculated. The Comprehensive Meta-Analysis software (CMA) software was used for the analysis. The Newcastle-Ottawa Scale (NOS) was used for the quality assessment.
Results:
A total of five observational cohort studies were included in this systematic review. The studies recruited cases from 2009 and 2020, predominantly in Korea and Japan. Data from 18,425 cases obtained from four studies were analyzed. The duration of antiplatelet therapy varied widely across the included studies. Additionally, most studies reported a median follow-up of 24 months or more after antiplatelet discontinuation. We extracted and analyzed the odds of thromboembolic complications occurring within 6 to 24 months after the discontinuation of antiplatelets. The pooled rate of thromboembolism after antiplatelet discontinuation in this meta-analysis was 0.01 (95% CI: 0.006 to 0.018).
Conclusion:
This review demonstrates that the risk of thromboembolic complications after discontinuing antiplatelet therapy post-SACE is low. However, no strong consensus exists on the ideal duration for maintaining dual- or single-antiplatelet therapy. Further prospective studies with longer follow-ups are warranted to clarify the optimal durations needed to balance thromboembolic risk with hemorrhagic complications.
