Analysis of Cerebrovascular Events after Coil Embolization of Unruptured Cerebral Aneurysms in Patients Taking Anticoagulants

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Objective: Antiplatelet therapy is advised to prevent thrombotic complications during endovascular coil embolization of unruptured cerebral aneurysms. Due to multiple antithrombotic treatments, bleeding risk is a concern in patients using oral anticoagulants for existing comorbidities. We investigated the hemorrhagic and ischemic events following endovascular treatment (EVT) of unruptured cerebral aneurysms in patients taking anticoagulation and antiplatelet therapy.

Methods: Between March 2013 and February 2019, 262 patients undergoing EVT for unruptured cerebral aneurysms and having at least 6 months of postoperative follow-up data were included in this retrospective study. Patients taking oral anticoagulants and antiplatelet drugs for cerebral vascular events following EVT were compared with those taking only antiplatelet agents.

Results: Of the 262 patients, 12 (4.6%) used anticoagulants before EVT for a preexisting condition. Cerebrovascular events after coil embolization were observed in 3 patients taking both anticoagulant and antiplatelet drugs and in 14 patients taking only antiplatelet drugs (25% vs. 5.6%, respectively, p = 0.035). Vitamin K antagonist (VKA) was administered in five patients and direct oral anticoagulants (DOACs) in seven patients. Patients taking VKA experienced cerebrovascular events, whereas those taking DOACs did not (p = 0.045).

Conclusion: Our study showed that patients using oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after EVT for unruptured cerebral aneurysms. These results suggest that in patients requiring oral anticoagulants, DOACs may be more beneficial than VKA for preventing stroke occurrences after EVT.