Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis
The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-re...
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| Veröffentlicht in: | Neurosurgical review 2020-04, Vol.43 (2), p.397-406 |
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| creator | Cagnazzo, Federico Di Carlo, Davide Tiziano Petrella, Giandomenico Perrini, Paolo |
| description | The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients
with
and
without
AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516
=
20.9%, 95% CI = 11.9–30%,
I
2
= 90% vs 57/647 = 9%, 95% CI = 5.5–12.5%,
I
2
= 45.8%) (
p
|
| doi_str_mv | 10.1007/s10143-018-0999-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2063713074</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2063713074</sourcerecordid><originalsourceid>FETCH-LOGICAL-c410t-4d1fd8a843a13184fe55612585066cef251a3f817caf2fd8a16a65a4565b103c3</originalsourceid><addsrcrecordid>eNp9kc1u1TAQRi0EopfCA7BBXrJxmYnzu6wqCkiV2ABba5pMelMlcRjbSHkY3hVf3cKSlSX7fMdjf0q9RbhCgOZDQMDSGsDWQNd1Bp6pQ95oTGELeK4OYMvSVDU0F-pVCI8A2HSAL9VF0XV1i01xUL9_8Bpl6tPsQ_TLboRnijzoIy9e5EgPrKdVbxSnDAbtV01rnLYTNHPU8chC265HL5rXwf-ikF0kOgpTXHJG-1FTnzK-a0lbTJLtU76UeqF1ojkLOckelnClr_XCkQytNO9hCq_Vi5HmwG-e1kv1_fbjt5vP5u7rpy8313emLxGiKQcch5ba0hJabMuRq6rGomorqOuex6JCsmN-cE9jcSKxprqisqqrewTb20v1_uzdxP9MHKJbptDzPOfRfAqugNo2aKEpM4pntBcfgvDoNpkWkt0huFMr7tyKy624UysOcubdkz7dLzz8S_ytIQPFGQj5aH1gcY8-Sf6E8B_rH0OunGk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2063713074</pqid></control><display><type>article</type><title>Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis</title><source>SpringerLink Journals - AutoHoldings</source><creator>Cagnazzo, Federico ; Di Carlo, Davide Tiziano ; Petrella, Giandomenico ; Perrini, Paolo</creator><creatorcontrib>Cagnazzo, Federico ; Di Carlo, Davide Tiziano ; Petrella, Giandomenico ; Perrini, Paolo</creatorcontrib><description>The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients
with
and
without
AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516
=
20.9%, 95% CI = 11.9–30%,
I
2
= 90% vs 57/647 = 9%, 95% CI = 5.5–12.5%,
I
2
= 45.8%) (
p
< 0.0001). Major EVD-associated hemorrhage rates were low in both the AT and control group (25/480 = 4.4%, 95% CI = 1.7–7.7%,
I
2
= 53.9% vs 6/647 = 0.7%, 95% CI = 0.03–1.7%,
I
2
= 0%) (
p
< 0.0001). Ventriculostomy before embolization and intraprocedural AT were associated with lower rates of EVD-related bleeding (32/230 = 9.6%, 95% CI = 2.1–17.1%,
I
2
= 75.4% vs 6/24 = 25.1%, 95% CI = 8.8–41%,
I
2
= 0%) (
p
< 0.02). The rate of major hemorrhage was higher after dual AT (CP + ASA) compared to single AT (ASA or CP) used as an intraprocedural loading dose (13/173 = 7%, 95% CI = 3.3–10.7%,
I
2
= 0% vs 6/210 = 1.7%, 95% CI = 0.1–3.4%,
I
2
= 0%) (
p
< 0.009). AT during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages, although most of them are small and asymptomatic. When ventriculostomy is performed before endovascular procedures requiring antiplatelet administration, the hemorrhagic risk is minimized. A single antiplatelet therapy is associated with a lower rate of major bleeding than a dual therapy.</description><identifier>ISSN: 0344-5607</identifier><identifier>EISSN: 1437-2320</identifier><identifier>DOI: 10.1007/s10143-018-0999-0</identifier><identifier>PMID: 29968172</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Medicine ; Medicine & Public Health ; Neurosurgery ; Review</subject><ispartof>Neurosurgical review, 2020-04, Vol.43 (2), p.397-406</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-4d1fd8a843a13184fe55612585066cef251a3f817caf2fd8a16a65a4565b103c3</citedby><cites>FETCH-LOGICAL-c410t-4d1fd8a843a13184fe55612585066cef251a3f817caf2fd8a16a65a4565b103c3</cites><orcidid>0000-0003-3159-1678</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10143-018-0999-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10143-018-0999-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29968172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cagnazzo, Federico</creatorcontrib><creatorcontrib>Di Carlo, Davide Tiziano</creatorcontrib><creatorcontrib>Petrella, Giandomenico</creatorcontrib><creatorcontrib>Perrini, Paolo</creatorcontrib><title>Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis</title><title>Neurosurgical review</title><addtitle>Neurosurg Rev</addtitle><addtitle>Neurosurg Rev</addtitle><description>The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients
with
and
without
AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516
=
20.9%, 95% CI = 11.9–30%,
I
2
= 90% vs 57/647 = 9%, 95% CI = 5.5–12.5%,
I
2
= 45.8%) (
p
< 0.0001). Major EVD-associated hemorrhage rates were low in both the AT and control group (25/480 = 4.4%, 95% CI = 1.7–7.7%,
I
2
= 53.9% vs 6/647 = 0.7%, 95% CI = 0.03–1.7%,
I
2
= 0%) (
p
< 0.0001). Ventriculostomy before embolization and intraprocedural AT were associated with lower rates of EVD-related bleeding (32/230 = 9.6%, 95% CI = 2.1–17.1%,
I
2
= 75.4% vs 6/24 = 25.1%, 95% CI = 8.8–41%,
I
2
= 0%) (
p
< 0.02). The rate of major hemorrhage was higher after dual AT (CP + ASA) compared to single AT (ASA or CP) used as an intraprocedural loading dose (13/173 = 7%, 95% CI = 3.3–10.7%,
I
2
= 0% vs 6/210 = 1.7%, 95% CI = 0.1–3.4%,
I
2
= 0%) (
p
< 0.009). AT during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages, although most of them are small and asymptomatic. When ventriculostomy is performed before endovascular procedures requiring antiplatelet administration, the hemorrhagic risk is minimized. A single antiplatelet therapy is associated with a lower rate of major bleeding than a dual therapy.</description><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Review</subject><issn>0344-5607</issn><issn>1437-2320</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kc1u1TAQRi0EopfCA7BBXrJxmYnzu6wqCkiV2ABba5pMelMlcRjbSHkY3hVf3cKSlSX7fMdjf0q9RbhCgOZDQMDSGsDWQNd1Bp6pQ95oTGELeK4OYMvSVDU0F-pVCI8A2HSAL9VF0XV1i01xUL9_8Bpl6tPsQ_TLboRnijzoIy9e5EgPrKdVbxSnDAbtV01rnLYTNHPU8chC265HL5rXwf-ikF0kOgpTXHJG-1FTnzK-a0lbTJLtU76UeqF1ojkLOckelnClr_XCkQytNO9hCq_Vi5HmwG-e1kv1_fbjt5vP5u7rpy8313emLxGiKQcch5ba0hJabMuRq6rGomorqOuex6JCsmN-cE9jcSKxprqisqqrewTb20v1_uzdxP9MHKJbptDzPOfRfAqugNo2aKEpM4pntBcfgvDoNpkWkt0huFMr7tyKy624UysOcubdkz7dLzz8S_ytIQPFGQj5aH1gcY8-Sf6E8B_rH0OunGk</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Cagnazzo, Federico</creator><creator>Di Carlo, Davide Tiziano</creator><creator>Petrella, Giandomenico</creator><creator>Perrini, Paolo</creator><general>Springer Berlin Heidelberg</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3159-1678</orcidid></search><sort><creationdate>20200401</creationdate><title>Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis</title><author>Cagnazzo, Federico ; Di Carlo, Davide Tiziano ; Petrella, Giandomenico ; Perrini, Paolo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-4d1fd8a843a13184fe55612585066cef251a3f817caf2fd8a16a65a4565b103c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cagnazzo, Federico</creatorcontrib><creatorcontrib>Di Carlo, Davide Tiziano</creatorcontrib><creatorcontrib>Petrella, Giandomenico</creatorcontrib><creatorcontrib>Perrini, Paolo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgical review</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cagnazzo, Federico</au><au>Di Carlo, Davide Tiziano</au><au>Petrella, Giandomenico</au><au>Perrini, Paolo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis</atitle><jtitle>Neurosurgical review</jtitle><stitle>Neurosurg Rev</stitle><addtitle>Neurosurg Rev</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>43</volume><issue>2</issue><spage>397</spage><epage>406</epage><pages>397-406</pages><issn>0344-5607</issn><eissn>1437-2320</eissn><abstract>The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients
with
and
without
AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516
=
20.9%, 95% CI = 11.9–30%,
I
2
= 90% vs 57/647 = 9%, 95% CI = 5.5–12.5%,
I
2
= 45.8%) (
p
< 0.0001). Major EVD-associated hemorrhage rates were low in both the AT and control group (25/480 = 4.4%, 95% CI = 1.7–7.7%,
I
2
= 53.9% vs 6/647 = 0.7%, 95% CI = 0.03–1.7%,
I
2
= 0%) (
p
< 0.0001). Ventriculostomy before embolization and intraprocedural AT were associated with lower rates of EVD-related bleeding (32/230 = 9.6%, 95% CI = 2.1–17.1%,
I
2
= 75.4% vs 6/24 = 25.1%, 95% CI = 8.8–41%,
I
2
= 0%) (
p
< 0.02). The rate of major hemorrhage was higher after dual AT (CP + ASA) compared to single AT (ASA or CP) used as an intraprocedural loading dose (13/173 = 7%, 95% CI = 3.3–10.7%,
I
2
= 0% vs 6/210 = 1.7%, 95% CI = 0.1–3.4%,
I
2
= 0%) (
p
< 0.009). AT during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages, although most of them are small and asymptomatic. When ventriculostomy is performed before endovascular procedures requiring antiplatelet administration, the hemorrhagic risk is minimized. A single antiplatelet therapy is associated with a lower rate of major bleeding than a dual therapy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29968172</pmid><doi>10.1007/s10143-018-0999-0</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-3159-1678</orcidid></addata></record> |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Medicine Medicine & Public Health Neurosurgery Review |
| title | Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis |
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