Nuisance bleeding complications in patients with cerebral aneurysm treated with Pipeline embolization device

Elliot Pressman, Carlos A. De La Garza, Felix Chin, Jacob Fishbein, Muhammad Waqas, Adnan Siddiqui, Kenneth Snyder, Jason M. Davies, Elad Levy, Peter Kan, Zeguang Ren, Maxim Mokin

Research output: Contribution to journalArticle

Abstract

Background: Patients with cerebral aneurysms treated with the Pipeline embolization device (PED) are maintained on dual antiplatelet therapy (DAPT) to prevent thromboembolic complications. Rates of minor, "nuisance"bleeding in these patients remain unknown. We sought to evaluate the frequency and factors associated with this bleeding and its effect on DAPT compliance. Methods: We performed a multicenter retrospective cohort study on consecutive cases of intracranial aneurysms treated with PED. Patient characteristics, aneurysm characteristics, and bleeding complications were analyzed. Severity of bleeding was defined according to a previously published classification defining nuisance bleeding as easy bruising, bleeding from small cuts, petechia, and ecchymosis. Results: 245 PED aneurysm procedures on 243 patients were retrospectively collected from three academic centers over a 4.25-year period. Sixty-seven patients (27%) had nuisance bleeds. Patients with a higher risk of nuisance bleeding were older (59.1±3.4 vs. 54.7±2.2, P=0.032). Patients with nuisance bleeds were more likely to have their DAPT regimen changed or dose lowered (29% vs 8.3%, P<0.001), were on DAPT for less time (10.0 months±2.60 vs. 14.6 months±1.95, P=0.005) and were more likely to have aneurysm occlusion at 6 months (P<0.001). Stepwise logistic regression found age predictive of a nuisance bleed (OR=1.033) Conclusions: Nuisance bleeding was a common complaint of PED-treated aneurysm patients maintained on DAPT. Increasing age and aneurysmal occlusion at 6 months were the only factors predictive of nuisance bleeds. Clinicians were more likely to adjust antiplatelet regimens or stop DAPT early given a nuisance bleed.

Original languageEnglish (US)
Article number016245
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • aneurysm
  • flow diverter
  • hemorrhage
  • platelets
  • stent

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Pressman, E., De La Garza, C. A., Chin, F., Fishbein, J., Waqas, M., Siddiqui, A., Snyder, K., Davies, J. M., Levy, E., Kan, P., Ren, Z., & Mokin, M. (Accepted/In press). Nuisance bleeding complications in patients with cerebral aneurysm treated with Pipeline embolization device. Journal of neurointerventional surgery, [016245]. https://doi.org/10.1136/neurintsurg-2020-016245