Novel Application of Reversible Parental Anti-platelets in Patients with Aneurysmal Subarachnoid Hemorrhage (P1.257)

BACKGROUND/OBJECTIVE: The International Subarachnoid Aneurysm Trial (ISAT) showed a greater likelihood of survival free 1 year disability in patients undergoing endovascular coiling who were started on antiplatelet agents after SAH compared with neurosurgical clipping. However, data on safety of acute parental antiplatelet agents after aneurysmal coiling is lacking. Previously we reported on 5 patients that received acute intra-procedural eptifibatide followed by IV infusions. We now report 7 more patients to further asses safety of IV eptifibatide in patients presenting with acute subarachnoid hemorrhage undergoing endovascular coiling for aneurysmal embolization. DESIGN/METHODS: All the patients from 2009-2015 who presented to our university affiliated comprehensive stroke center with aneurysmal subarachnoid hemorrhage and underwent endovascular coiling were evaluated. Eptifibatide was administered intra-arterially as a 135-μg/kg single bolus, and then continued on intravenous infusion of 0.5-μg/kg/min post-procedurally. Charts were reviewed to assess for complications including symptomatic and asymptomatic intra- and extra-cranial hemorrhages, groin hematomas, epistaxis and gross hematuria. RESULTS:: Of the total of 101 patients treated with coil embolization during this period, 12 patients (mean age 55 years, received acute intra-procedural Eptifibatide followed by IV infusion for a mean duration of 71 hours (range 15.5-316 hours). Various reasons for use of Eptifibatide included: stent assist coiling [n=3], multiple stents for flow diversion [n=2], partial coil prolapse [n=2], angioplasty for vasospasm (n=1) and vascular lumen flow compromise [n=4]. None of the patients demonstrated symptomatic/asymptomatic hemorrhage, groin hematoma, epistaxis or hematuria. CONCLUSION: Our results highlight safety of administering IV Eptifibatide to prevent thrombotic complications after endovascular coil embolization in select patients with aneurysmal subarachnoid hemorrhage. Multicenter prospective trials are warranted to corroborate our findings Disclosure: Dr. Mehta has nothing to disclose. Dr. Moussavi has nothing to disclose. Dr. Korya has nothing to disclose. Dr. Brar has nothing to disclose. Dr. Chahal has nothing to disclose. Dr. Samaan has nothing to disclose. Dr. Daniel has nothing to disclose. Dr. Song has nothing to disclose. Dr. Kirmani has nothing to disclose.