Is it safe to discontinue antiplatelet medication after stent-assisted coil embolization? If so, when is the best time?

Abstract

Purpose: Antiplatelet maintenance after stent-assisted coil embolization (SACE) is generally considered essential to avoid post-procedural thromboembolic complications. However, there is still debate as to whether it is safe to discontinue antiplatelet drugs after SACE or when is the best time to do so. We investigate herein the clinical outcomes experienced by patients who discontinue antiplatelet agents after SACE.

Methods: From a prospective database, we retrieved the data for 120 consecutive patients (harboring 130 aneurysms) in whom antiplatelet agents were discontinued after SACE between January 2010 and December 2019. We defined thromboembolic complications associated with discontinuation as neurologic or radiographic ischemia that occurred within 6 months of discontinuation of antiplatelet agents; the lesion was required to be correlated with the stented artery.

Results: The mean time of discontinuation of antiplatelet medication was 31.4 ± 18.3 months after SACE (median, 26 months). The majority of patients stopped antiplatelet medication between 18 and 36 months after SACE (74 patients, 61.6%). Laser-cut closed-cell stent was most commonly applied in 91 aneurysms (70.0%), followed by braided closed-cell (n=29; 22.3 %) and laser-cut open-cell stent 10 (7.7 %). No patients experienced cerebral ischemia related to discontinuation of antiplatelet medication.

Conclusion: Our preliminary study suggests that it may be safe to discontinue antiplatelet medication after SACE in patients at low risk for ischemia. The optimal time to discontinue might be around 18 to 36 months after SACE. Large cohort-based studies or randomized clinical trials are warranted to confirm these results.

Keywords: Aneurysm; Antiplatelet; Coil; Embolization; Medication; Stent.