A comparison of therapeutic effects of two antithrombotic regimens after stent assisted embolization for intracranial ruptured aneurysms

LI Gang; ZHENG Jianfeng; ZHANG Jiachun; SUN Xiaochuan

Abstract：Objective To compare the efficacy of direct antiplatelet therapy and anticoagulation therapy followed by antiplatelet therapy after intracranial aneurysm stent-assisted interventional embolization.Methods A retrospective cohort study was conducted to analyze the 142 patients with ruptured intracranial aneurysms who underwent stent-assisted interventional embolization in the First Affiliated Hospital of Chongqing Medical University from January 2019 to December 2021.According to the postoperative antithrombotic regimen,37 patients(26.1%)were in the antiplatelet group and 105 patients(73.9%)were in the anticoagulant+antiplatelet group.The differences of age,sex,diabetes,hypertension,postoperative bleeding and ischemic complications,aneurysm size,aneurysm number and aneurysm location were compared between these two groups.All patients were followed up clinically.By analyzing the number of postoperative bleeding events and ischemic events and evaluating mRS Scores 2-5 months after discharge(mean:3 months),the short-term pre-evaluation efficacy of different treatment regimens between the two groups was compared.Results There were no significant differences in age,sex,hypertension,diabetes,aneurysm number,aneurysm size and aneurysm location between the two groups(P>0.05).A total of 29 patients experienced bleeding complications after intervention,including 12 cases in the full course antiplatelet group and 17 cases in the anticoagulant first group followed by antiplatelet combined group.Compared with the antiplatelet group,the incidence of bleeding complications in the anticoagulant first group followed by antiplatelet therapy was lower(16.2%vs 32.4%;P<0.05).There was no significant difference in the rate of good clinical prognosis(81.1%vs 81.0%),poor clinical prognosis(18.9%vs 19.0%)and mortality(5.4%vs 2.9%).Conclusions Compared with full course antiplatelet therapy,anticoagulation therapy followed by antiplatelet therapy can reduce the incidence of bleeding complications in patients with intracranial ruptured aneurysms undergoing stent assisted embolization.