Department of Radiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
J Neurointerv Surg. 2013 Sep 1;5(5):405-9. doi: 10.1136/neurintsurg-2012-010359. Epub 2012 Jun 7.
Little is known about the safety of long-term anticoagulation in patients with unruptured saccular intracranial aneurysms, although case reports of anticoagulation in patients with fusiform and saccular aneurysms have been published. The goal of this study was to estimate the rate of subarachnoid hemorrhage (SAH) due to aneurysm rupture in patients with intracranial saccular aneurysms receiving therapeutic doses of anticoagulation.
This was a retrospective case series of patients with intradural aneurysms receiving therapeutic doses of anticoagulation (defined as a dose that achieves a target INR >2.0 or the equivalent dose of another anticoagulant). The primary outcome was SAH due to aneurysm rupture while receiving anticoagulation treatment. The rate of SAH due to aneurysm rupture was calculated among patients with aneurysms documented on imaging.
42 patients with 48 intradural aneurysms on anticoagulation were identified. Their mean age was 67 years (range 40-83) and 28 (67%) were women. The mean aneurysm size was 5.1±3.6 mm and 40 (83%) aneurysms were in the anterior circulation. The mean±SD follow-up was 495±749 days per patient. Twelve patients had their aneurysms coiled, clipped or surgically wrapped before the period of anticoagulation. Three patients had clipping or coiling of their aneurysms during the period of anticoagulation. Six patients had a history of aneurysm rupture prior to anticoagulation, of which two were treated by coiling and four by clipping. Among the 48 aneurysms, 32 were never coiled or clipped prior to anticoagulation. No anticoagulated patients with known aneurysms developed SAH during 57 patient-years of follow-up. The patients with untreated aneurysms had 31 patient-years of follow-up and those who underwent clipping, coiling or surgical wrapping of their aneurysms had 26 patient-years of follow-up while receiving anticoagulation (for a combined total of 57 years of follow up).
The risk of aneurysm rupture is not increased in patients receiving systemic anticoagulation. However, these results should be interpreted with caution given the small sample size in this study and the need for a prospective study to confirm these findings.
尽管已有关于梭形和囊状动脉瘤患者抗凝治疗的病例报告发表，但对于未破裂的囊状颅内动脉瘤患者长期抗凝治疗的安全性知之甚少。本研究旨在评估接受治疗剂量抗凝治疗的颅内囊状动脉瘤患者发生蛛网膜下腔出血（SAH）的破裂率。
这是一项回顾性病例系列研究，纳入了接受治疗剂量抗凝治疗（定义为达到目标 INR>2.0 或其他抗凝剂等效剂量的剂量）的硬脊膜内动脉瘤患者。主要结局是接受抗凝治疗时因动脉瘤破裂而导致的 SAH。计算影像学检查有动脉瘤的患者中因动脉瘤破裂而导致的 SAH 发生率。
共确定了 42 例在抗凝治疗期间有 48 个硬脊膜内动脉瘤的患者。他们的平均年龄为 67 岁（范围为 40-83 岁），28 例（67%）为女性。平均动脉瘤大小为 5.1±3.6mm，40 个（83%）动脉瘤位于前循环。每位患者的平均±SD 随访时间为 495±749 天。在抗凝治疗前，有 12 例患者的动脉瘤进行了弹簧圈栓塞、夹闭或手术包裹。在抗凝治疗期间，有 3 例患者的动脉瘤进行了夹闭或弹簧圈栓塞。在抗凝治疗前，有 6 例患者有动脉瘤破裂史，其中 2 例接受了弹簧圈栓塞治疗，4 例接受了夹闭治疗。在 48 个动脉瘤中，有 32 个在抗凝治疗前从未进行过弹簧圈栓塞或夹闭治疗。在 57 个患者年的随访期间，没有接受抗凝治疗且已知有动脉瘤的患者发生 SAH。未治疗动脉瘤患者的随访时间为 31 个患者年，接受夹闭、弹簧圈栓塞或手术包裹动脉瘤的患者在接受抗凝治疗期间的随访时间为 26 个患者年（总随访时间为 57 年）。
接受全身抗凝治疗的患者动脉瘤破裂风险并未增加。然而，鉴于本研究样本量较小，需要前瞻性研究来证实这些发现，因此应谨慎解释这些结果。
