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Liu H, Shao T, Yang T, Li D, Wang H, Cheng Y, Zhang T, Zhang J. Comparison of Cilostazol versus Clopidogrel in Addition to Aspirin in Patients with Ischemic Stroke who Underwent Intracranial or Extracranial Artery Stent Implantation. J Atheroscler Thromb 2023; 30:1010-1021. [PMID: 36328566 PMCID: PMC10406684 DOI: 10.5551/jat.63632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/19/2022] [Indexed: 08/04/2023] Open
Abstract
AIMS The role of cilostazol after intracranial or extracranial artery stent implantation is still unclear. Therefore, we designed this trial to explore the efficacy and safety of cilostazol in this particular population. METHODS In this retrospective study, patients were divided into the cilostazol or clopidogrel group by the antiplatelet therapy received after artery stent implantation. The primary efficacy endpoint was ischemic stroke. Bleeding events and other antiplatelet drug-related adverse reactions (ADRs) were also recorded. Neurological function prognosis was evaluated by the modified Rankin Scale (mRS) after discharge. RESULTS A total of 156 patients were enrolled; 56 underwent intracranial artery stenting, 95 underwent extracranial artery stenting, and 5 underwent intracranial combined with extracranial artery stenting. Any stroke and bleeding events in the hospital of the two groups were comparable (P=0.38, P=0.34, respectively). The incidence of stroke recurrence tended to be lower in the cilostazol group, although not significant (cilostazol vs. clopidogrel, 1.35% vs. 4.88%, P=0.25). There was a significant difference of any bleeding events between the two groups (cilostazol vs. clopidogrel, 5.41% vs. 20.73%, P=0.02). During follow-up, we did not observe an apparent increase of ADRs in the cilostazol group (cilostazol vs. clopidogrel, palpitation 4.05% vs. 2.44%, P=0.58; gastrointestinal discomfort events 8.11% vs. 12.20%, P=0.80). There were no differences between the two groups of neurological function prognosis (P=0.29). CONCLUSIONS Cilostazol-based dual antiplatelet therapy could be recommended as an effective and safe therapy regimen among patients undergoing intracranial or extracranial artery stent implantation.
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Affiliation(s)
- Hui Liu
- China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tengfei Shao
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tao Yang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Di Li
- Department of Pharmacy, Wuhan No.1 Hospital, Wuhan, Hubei, China
| | - Huan Wang
- Department of Pharmacy, Wuhan Fourth Hospital,Wuhan,Hubei, China
| | - Yue Cheng
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tingzheng Zhang
- Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Jinping Zhang
- China Pharmaceutical University Nanjing Drum Tower Hospital, Nanjing, Jiangsu, China
- Department of Pharmacy, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
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Hanada H, Nii K, Sakamoto K, Inoue R, Hirata Y, Matsuda K, Tsugawa J, Takeshita S, Shirakawa S, Higashi T. Analysis of Cerebrovascular Events after Coil Embolization of Unruptured Cerebral Aneurysms in Patients Taking Anticoagulants. JOURNAL OF NEUROENDOVASCULAR THERAPY 2023; 17:73-79. [PMID: 37502350 PMCID: PMC10370510 DOI: 10.5797/jnet.oa.2022-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/11/2022] [Indexed: 07/29/2023]
Abstract
Objective Antiplatelet therapy is advised to prevent thrombotic complications during endovascular coil embolization of unruptured cerebral aneurysms. Due to multiple antithrombotic treatments, bleeding risk is a concern in patients using oral anticoagulants for existing comorbidities. We investigated the hemorrhagic and ischemic events following endovascular treatment (EVT) of unruptured cerebral aneurysms in patients taking anticoagulation and antiplatelet therapy. Methods Between March 2013 and February 2019, 262 patients undergoing EVT for unruptured cerebral aneurysms and having at least 6 months of postoperative follow-up data were included in this retrospective study. Patients taking oral anticoagulants and antiplatelet drugs for cerebral vascular events following EVT were compared with those taking only antiplatelet agents. Results Of the 262 patients, 12 (4.6%) used anticoagulants before EVT for a preexisting condition. Cerebrovascular events after coil embolization were observed in 3 patients taking both anticoagulant and antiplatelet drugs and in 14 patients taking only antiplatelet drugs (25% vs. 5.6%, respectively, p = 0.035). Vitamin K antagonist (VKA) was administered in five patients and direct oral anticoagulants (DOACs) in seven patients. Patients taking VKA experienced cerebrovascular events, whereas those taking DOACs did not (p = 0.045). Conclusion Our study showed that patients using oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after EVT for unruptured cerebral aneurysms. These results suggest that in patients requiring oral anticoagulants, DOACs may be more beneficial than VKA for preventing stroke occurrences after EVT.
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Affiliation(s)
- Hayatsura Hanada
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
- Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Chikushino, Fukuoka, Japan
| | - Kouhei Nii
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
- Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Chikushino, Fukuoka, Japan
| | - Kimiya Sakamoto
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Ritsurou Inoue
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Yoko Hirata
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Kodai Matsuda
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Jun Tsugawa
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Sho Takeshita
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Sachiko Shirakawa
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Toshio Higashi
- Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
- Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Chikushino, Fukuoka, Japan
- Stroke Center, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Riegler C, Keil F, Petzold GC, Bode FJ, Reich A, Nikoubashman O, Röther J, Eckert B, Braun M, Hamann GF, Siebert E, Nolte CH, Bohner G, Eckert RM, Borggrefe J, Schellinger P, Berrouschot J, Bormann A, Kraemer C, Leischner H, Petersen M, Stögbauer F, Boeck-Behrens T, Wunderlich S, Ludolph A, Henn KH, Gerloff C, Fiehler J, Thomalla G, Alegiani A, Schäfer JH, Tiedt S, Kellert L, Trumm C, Ernemann U, Poli S, Liman J, Ernst M, Gröschel K, Uphaus T. Antithrombotic treatment and outcome after endovascular treatment and acute carotid artery stenting in stroke patients with atrial fibrillation. Neurol Res Pract 2022; 4:42. [PMID: 36089621 PMCID: PMC9465921 DOI: 10.1186/s42466-022-00207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days. Results Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high. Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 [interquartile range, 3–10.5] vs 7 [4–11], p = 0.73, mRS 4 [IQR 3–4] vs. 4 [IQR 3–5], p = 0.79), but 90-day mortality was higher without OAC (32 vs 4%, p = 0.02). Conclusions In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC. Registration: https://www.clinicaltrials.gov; Unique identifier: NCT03356392. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-022-00207-7.
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Pardo-Galiana B, Medina-Rodriguez M, Millan-Vazquez M, Cabezas-Rodriguez JA, Lebrato-Hernandez L, Ainz-Gomez L, Zapata-Arriaza E, Ortega J, de Albóniga-Chindurza A, Montaner J, Gonzalez A, Moniche F. Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation. AJNR Am J Neuroradiol 2022; 43:727-730. [PMID: 35393364 PMCID: PMC9089259 DOI: 10.3174/ajnr.a7482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Antithrombotic therapy following carotid artery stent placement with concomitant atrial fibrillation is not well-established. Our aim was to assess the safety and efficacy of the combination of direct oral anticoagulants and a P2Y12 inhibitor at 30 days after carotid artery stent placement in patients with atrial fibrillation. MATERIALS AND METHODS We designed an observational single-center study including patients who underwent carotid artery stent placement with concomitant atrial fibrillation. We studied 3 groups according to antithrombotic therapy: 1) the direct oral anticoagulants plus clopidogrel (DC) group: receiving direct oral anticoagulants plus a P2Y12 inhibitor; 2) the triple therapy group: anticoagulation and dual antiplatelet therapy; and 3) the dual antiplatelet therapy group: following dual antiplatelet therapy alone. The safety outcome was a major or clinically relevant non-major bleeding event at the first month. The efficacy outcomes were the thromboembolic events (myocardial infarction, stroke, systemic embolism, or stent thrombosis). RESULTS Of 959 patients with carotid artery stent placement, 91 met the inclusion criteria, including 24 patients in the DC group, 42 patients in the triple therapy group, and 25 in the dual antiplatelet therapy group. The mean age was 72.27 (SD, 8.1 ) years, with similar baseline characteristics. The median CHA2DS2-VASc score for each group was 6 (interquartile range = 5-6), 5 (interquartile range = 4-6), and 5 (interquartile range = 4-6), respectively. The median HAS-BLED score was 4 in the 3 groups (P = .17). The primary safety end point was 23.8% in the triple therapy group compared with 4% in the dual antiplatelet therapy group (P = .032), with no bleeding events in the DC group (P = .007). There was 1 stent thrombosis in DC group and a cardioembolic stroke in the dual antiplatelet therapy group (P = .41). CONCLUSIONS Among patients with carotid artery stent placement with atrial fibrillation, triple therapy confers a high bleeding risk. A regimen of direct oral anticoagulants plus a P2Y12 inhibitor might confer a good safety profile with significantly lower rates of bleeding and optimal efficacy.
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Affiliation(s)
- B Pardo-Galiana
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - M Medina-Rodriguez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | | | - J A Cabezas-Rodriguez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - L Lebrato-Hernandez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - L Ainz-Gomez
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - E Zapata-Arriaza
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - J Ortega
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - A de Albóniga-Chindurza
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - J Montaner
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
- Stroke Unit (J.M.), Neurology Department, University Hospital Virgen Macarena, Seville, Spain
| | - A Gonzalez
- Interventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
| | - F Moniche
- From the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., F.M.)
- Neurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L.L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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