Background: Literature has reported the application of oral Aspirin and/or Clopidogrel in significantly reducing thromboembolic complications after aneurysmal coiling. There is a lack of data on intravenous Eptifibatide use as the choice of antiplatelet agent in the setting of elective cerebral aneurysmal embolization. Previously we reported on safety outcomes on 19 patients that received intravenous Eptifibatide while undergoing elective embolization of cerebral aneurysms. We now report on more patients to further assess safety outcome with the aim of further corroborating our previous findings.
Methods: Of all the patients that underwent elective cerebral aneurysmal embolization from 2010-2015 at our university affiliated comprehensive stroke center, patients that received Eptifibatide after aneurysmal embolization were reviewed. Eptifibatide was administered intra-arterially as a 135-μg/kg single-dose bolus, and then continued on intravenous infusion of 0.5-μg/kg/min post-procedurally. Inclusion criteria included clinically assessed risk of clot formation or propagation based on angiographic characteristics. Charts were reviewed for all patients to assess for medical/procedural complications including symptomatic and asymptomatic hemorrhages, groin hematoma, epistaxis and gross hematuria.
Results: A total of 30 patients (mean age 61, 22% male [n=7]) received Eptifibatide for a mean duration of 19 hours (range 4-29 hours). The aneurysmal size ranged from 2.4 to 23 mm and 83% [n=25] were located in anterior circulation. None of the patients demonstrated symptomatic/asymptomatic hemorrhage. One patient had a groin hematoma without need of transfusion.
Conclusion: IV Eptifibatide may represent another safe option for rapid and reversible antiplatelet therapy for reduction of thromboembolic complication associated with aneurysmal embolization in select patient population.