替罗非班在颅内破裂动脉瘤介入治疗术中预防性应用研究

The prophylactic application of tirofiban in interventional treatment for ruptured intracranial aneurysms: a clinical research

目的探讨替罗非班在颅内破裂动脉瘤介入栓塞治疗术中应用的安全性和有效性。方法回顾性分析2012年1月至2014年11月因颅内动脉瘤破裂在河南省人民医院接受介入栓塞治疗且术中应用替罗非班患者的临床资料。替罗非班应用方案:支架释放前或单纯弹簧圈栓塞完成时经静脉给予负荷剂量(8.0μg/kg,3 min内推注完毕),继而维持剂量(0.1μg·kg-1·min-1)至术后24 h,撤药前2 h给予负荷剂量抗血小板口服药物替换。观察分析替罗非班相关颅内出血和血栓栓塞事件。结果入组208例患者中支架辅助栓塞166例(79.81%),单纯弹簧圈栓塞42例(20.19%)。替罗非班相关颅内出血4例(1.92%,均发生在支架辅助栓塞队列),其中术中3例(1.44%),术后1例(0.48%);血栓栓塞事件6例(2.88%,支架辅助栓塞5例,单纯弹簧圈栓塞1例),其中术中支架内血栓形成1例(0.48%),术后维持用药期间血栓栓塞相关症状5例(2.40%)。结论经静脉负荷剂量继而维持剂量替罗非班在颅内破裂动脉瘤介入栓塞治疗术中预防性应用是安全、有效的。

Objective To evaluate the safety and efficacy of the prophylactic use of tirofiban in endovascular treatment of ruptured intracranial aneurysms. Methods The clinical data of 208 patients with ruptured intracranial aneurysm, who were admitted to Henan Provincial People＇s Hospital during the period from January 2012 to November 2014 to receive interventional embolization therapy and intra- operative infusion of tirofiban, were retrospectively analyzed. The application scheme of tirofiban was as follows ： before the deployment of stent or after the complete of simple coil embolization, a load dose of tirofiban was intravenously administrated（8.0 μg/kg, injection in 3 min）, which was followed by a maintenance dose（0.1 μg/kg/min） lasting for 24 hours. Loading dose of antiplatelet drugs was orally given two hours before the cessation of tirofiban infusion. Events of intracranial hemorrhage and thromboembolism related to tirofiban were recorded and the results were analyzed. Results Of the 208 patients, stent- assisted coil embolization was performed in 166（79.81%） and simple coil embolization in 42（20.19%）. Tirofiban- related intracranial hemorrhage occurred in 4 patients（1.92%）, all of the 4 patients received stent- assisted coil embolization;during the operation hemorrhage occurred in 3 patients（1.44%） and after the operation in 1 patients（0.48%）.Thromboembolic events occurred in 6 patients（2.88%）, among them stent- assisted coil embolization was employed in 5 patients and simple coil embolization in one patient; the thromboembolic events occurred during the operation in one patient（0.48%） and after the operation when postoperative use of tirofiban was still maintained in 5 patients（2.40%）. Conclusion In interventional embolization treatment for ruptured intracranial aneurysms, intravenous infusion of a load dose of tirofiban followed by a maintenance dose of tirofiban is safe and effective.