PMID- 36693396
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230706
IS  - 2234-8565 (Print)
IS  - 2287-3139 (Electronic)
IS  - 2234-8565 (Linking)
VI  - 25
IP  - 2
DP  - 2023 Jun
TI  - Discontinuation of antiplatelet therapy after stent-assisted coil embolization 
      for cerebral aneurysms.
PG  - 132-142
LID - 10.7461/jcen.2023.E2022.10.009 [doi]
AB  - OBJECTIVE: Dual antiplatelet therapy (DAPT) is usually temporarily used after 
      stent-assisted coil embolization (SACE), and is commonly converted to mono 
      antiplatelet therapy (MAPT) for indefinitely. In this study, we aimed to find the 
      possibility of discontinuing MAPT, and to determine the proper period of DAPT 
      use. METHODS: We used the Standard Sample Cohort DB dataset from the National 
      Health Insurance Sharing Service. Among approximately 1 million people in the 
      dataset, SACE was performed in 214 patients whose data this study analyzed. The 
      relationship between discontinuation of antiplatelet therapy and intracranial 
      hemorrhage or cerebral infarction was analyzed using multiple logistic 
      regression, considering all confounding variables. The survival rate according to 
      the continuation of antiplatelet therapy was obtained using Kaplan-Meier 
      analysis, and the difference in survival rate according to the continuation of 
      antiplatelet therapy was verified using the log-rank test. The hazard ratio 
      according to continuation of antiplatelet therapy was obtained using the Cox 
      proportional hazards model. The analysis was conducted by applying the same 
      statistical method to the duration of DAPT use. RESULTS: Among 214 patients who 
      underwent SACE, 50, 159 and five patients continued, discontinued and did not use 
      antiplatelet therapy (except at the time of procedure), respectively. In multiple 
      logistic regression analysis, discontinuation of antiplatelet agents (including 
      aspirin) and the period of DAPT use did not affect the occurrence of intracranial 
      hemorrhage or cerebral infarction, considering various confounding factors. In 
      the survival analysis according to the continuation of antiplatelet agents, 
      patients who continued to use antiplatelet agents had a higher survival rate than 
      those in other groups (p=0.00). The survival rate was higher in the rest of the 
      group than in the group that received DAPT for three months (p=0.00). 
      CONCLUSIONS: Continuation of antiplatelet agents or the period of DAPT use did 
      not affect the occurrence of intracranial hemorrhage or cerebral infarction. 
      Considering the survival rate, it would be better to maintain at least three 
      months of antiplatelet therapy and it might be recommended to continue DAPT use 
      for 12 months.
FAU - Kim, Tae Gon
AU  - Kim TG
AD  - Department of Neurosurgery, CHA Bundang Medical Center, CHA University, School of 
      Medicine, Seongnam, Korea.
LA  - eng
GR  - Kones-2020-04/Korean NeuroEndovascular Society/
PT  - Journal Article
DEP - 20230120
PL  - Korea (South)
TA  - J Cerebrovasc Endovasc Neurosurg
JT  - Journal of cerebrovascular and endovascular neurosurgery
JID - 101589154
PMC - PMC10318236
OTO - NOTNLM
OT  - Aneurysm
OT  - Antiplatelet therapy
OT  - Big data
OT  - Embolization
OT  - Statistical data analysis
OT  - Stent
EDAT- 2023/01/25 06:00
MHDA- 2023/01/25 06:01
PMCR- 2023/06/01
CRDT- 2023/01/24 18:50
PHST- 2022/10/24 00:00 [received]
PHST- 2022/12/20 00:00 [accepted]
PHST- 2023/01/25 06:01 [medline]
PHST- 2023/01/25 06:00 [pubmed]
PHST- 2023/01/24 18:50 [entrez]
PHST- 2023/06/01 00:00 [pmc-release]
AID - jcen.2023.E2022.10.009 [pii]
AID - jcen-2023-e2022-10-009 [pii]
AID - 10.7461/jcen.2023.E2022.10.009 [doi]
PST - ppublish
SO  - J Cerebrovasc Endovasc Neurosurg. 2023 Jun;25(2):132-142. doi: 
      10.7461/jcen.2023.E2022.10.009. Epub 2023 Jan 20.