Format

Send to

Choose Destination
Neurosurg Rev. 2018 Jul 2. doi: 10.1007/s10143-018-0999-0. [Epub ahead of print]

Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis.

Author information

1
Department of Neurosurgery, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy. f.cagnazzo86@gmail.com.
2
Department of Neurosurgery, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.

Abstract

The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients with and without AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516 = 20.9%, 95% CI = 11.9-30%, I2 = 90% vs 57/647 = 9%, 95% CI = 5.5-12.5%, I2 = 45.8%) (p < 0.0001). Major EVD-associated hemorrhage rates were low in both the AT and control group (25/480 = 4.4%, 95% CI = 1.7-7.7%, I2 = 53.9% vs 6/647 = 0.7%, 95% CI = 0.03-1.7%, I2 = 0%) (p < 0.0001). Ventriculostomy before embolization and intraprocedural AT were associated with lower rates of EVD-related bleeding (32/230 = 9.6%, 95% CI = 2.1-17.1%, I2 = 75.4% vs 6/24 = 25.1%, 95% CI = 8.8-41%, I2 = 0%) (p < 0.02). The rate of major hemorrhage was higher after dual AT (CP + ASA) compared to single AT (ASA or CP) used as an intraprocedural loading dose (13/173 = 7%, 95% CI = 3.3-10.7%, I2 = 0% vs 6/210 = 1.7%, 95% CI = 0.1-3.4%, I2 = 0%) (p < 0.009). AT during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages, although most of them are small and asymptomatic. When ventriculostomy is performed before endovascular procedures requiring antiplatelet administration, the hemorrhagic risk is minimized. A single antiplatelet therapy is associated with a lower rate of major bleeding than a dual therapy.

KEYWORDS:

Antiplatelet therapy; External ventricular drainage; Hemorrhage; Intracranial aneurysms; Subarachnoid hemorrhage; Ventriculostomy

PMID:
29968172
DOI:
10.1007/s10143-018-0999-0

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center