Trauma Center, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea.
Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Clin Neurol Neurosurg. 2020 Aug;195:106067. doi: 10.1016/j.clineuro.2020.106067. Epub 2020 Jul 6.
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.
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.
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).
"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.
在接受支架辅助弹簧圈栓塞颅内破裂动脉瘤的患者中，出现症状性脑积水时，有时需要进行脑室-腹腔分流术（VPS）。然而，对于使用双联抗血小板治疗（DAPT）的 VPS 围手术期管理，以及在血栓栓塞和出血并发症之间进行平衡，尚无指南。先前已经尝试了停止 DAPT 并用作用较弱的药物替代以降低出血风险的研究；然而，这些研究的样本量较小。本研究旨在调查在最近接受神经血管支架且需要 VPS 的患者中，停止 DAPT 并用布洛芬桥接治疗五天的安全性和可行性。
回顾性纳入了 41 例在神经血管支架放置后接受 DAPT 治疗并随后接受 VPS 的患者。根据围手术期 DAPT 治疗将患者分为两组：（1）桥接：停止 DAPT 并用布洛芬 600mg bid 替代五天，（2）继续：手术期间继续使用 DAPT。对两组进行比较，并调查出血并发症的危险因素。
在比较分析中，两组均未观察到缺血性并发症；然而，继续组的出血并发症明显高于桥接组（p=0.004）。在多变量逻辑回归分析中，“布洛芬桥接”被确定为与出血并发症负相关的显著因素（p=0.019）。
“停止 DAPT 并用布洛芬桥接治疗五天”可能是一种治疗策略，适用于最近接受神经血管支架放置且计划接受 VPS 手术的患者。
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