Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey
BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overv...
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| Published in | Journal of neurointerventional surgery Vol. 15; no. 4; pp. 402 - 407 |
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| Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format | Journal Article Web Resource |
| Language | English |
| Published |
BMA House, Tavistock Square, London, WC1H 9JR
BMJ Publishing Group Ltd
01.04.2023
BMJ Publishing Group LTD BMJ Journals NLM (Medline) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1759-8478 1759-8486 1759-8486 |
| DOI | 10.1136/neurintsurg-2021-018601 |
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| Abstract | BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.MethodsIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).ResultsAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.ConclusionThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field. |
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| AbstractList | BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.MethodsIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).ResultsAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.ConclusionThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field. Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.BACKGROUNDNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).METHODSIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.RESULTSAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.CONCLUSIONThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field. [en] BACKGROUND: Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. METHODS: In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). RESULTS: All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. CONCLUSION: This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field. Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field. Background Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. Methods In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). Results All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. Conclusion This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field. |
| Author | Caroff, Jildaz Burel, Julien Gauberti, Maxime Aubert, Laurent Janot, Kevin Moreno, Ricardo Sedat, Jacques Bintner, Marc Bricout, Nicolas Lavenu-Bombled, Cécile Ognard, Julien Bellanger, Guillaume Shotar, Eimad Drai, Maxime Liao, Liang Thouant, Pierre Figueiredo, Samy Veunac, Louis Tuilier, Titien Desilles, Jean Philippe Kerleroux, Basile Redjem, Hocine Traore, Abdoulaye Boucherit, Julien Alias, Quentin Bolognini, Federico Guedon, Alexis Laubacher, Morgane Delvoye, François Habchi, Kamelia Hak, Jean-Francois Consoli, Arturo Mihalea, Cristian Gazzola, Sebastian Zannoni, Riccardo Spelle, Laurent Darcourt, Jean Gariel, Florent L'Allinec, Vincent Zhu, François Heck, Olivier Forestier, Géraud Boulouis, Gregoire Hanafi, Riyad Ifergan, Heloise Dumas, Victor Testud, Benoit Soize, Sebastien Manceau, Pierre-François Pop, Raoul Eugene, Francois Chalumeau, Vanessa Dargazanli, Cyril Richter, Johann Sebastian Lefebvre, Margaux Girot, Jean-Baptiste Reyre, Anthony Derraz, Imad Charbonnier, Guillaume Cortese, Jonathan Tahon, Florence Duranteau, Jacques Aouni, Mour |
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Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France – sequence: 5 givenname: Kamelia surname: Habchi fullname: Habchi, Kamelia organization: Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France – sequence: 6 givenname: Jonathan orcidid: 0000-0002-1616-9113 surname: Cortese fullname: Cortese, Jonathan organization: Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France – sequence: 7 givenname: Francois orcidid: 0000-0001-7367-8793 surname: Eugene fullname: Eugene, Francois organization: Department of Radiology, CHU Rennes, Rennes, France – sequence: 8 givenname: Julien orcidid: 0000-0003-4495-7464 surname: Ognard fullname: Ognard, Julien organization: Department of Neuroradiology, CHU Brest, Brest, France – sequence: 9 givenname: Florence surname: Tahon fullname: Tahon, Florence organization: Department of Neuroradiology, Hôpital Privé Clairval, Marseille, France – sequence: 10 givenname: Géraud orcidid: 0000-0003-4797-9693 surname: Forestier fullname: Forestier, Géraud organization: Department of Neuroradiology, CHU Limoges, Limoges, France – sequence: 11 givenname: Heloise surname: Ifergan fullname: Ifergan, Heloise organization: Diagnostic and Interventional Neuroradiology, CHU Tours, Tours, France – sequence: 12 givenname: François orcidid: 0000-0003-3838-9608 surname: Zhu fullname: Zhu, François organization: Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France – sequence: 13 givenname: Jean-Francois orcidid: 0000-0002-0225-7876 surname: Hak fullname: Hak, Jean-Francois organization: Department of Neuroradiology, Hospital Timone, Marseille, France – sequence: 14 givenname: Anthony surname: Reyre fullname: Reyre, Anthony organization: Department of Neuroradiology, Hospital Timone, Marseille, France – sequence: 15 givenname: Morgane surname: Laubacher fullname: Laubacher, Morgane organization: Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France – sequence: 16 givenname: Abdoulaye surname: Traore fullname: Traore, Abdoulaye organization: Department of Neuroradiology, Hôpital Louis Pasteur, Colmar, France – sequence: 17 givenname: Jean Philippe surname: Desilles fullname: Desilles, Jean Philippe organization: Department of Interventional Neuroradiology, Fondation Rothschild, Paris, France – sequence: 18 givenname: Imad orcidid: 0000-0003-0632-3399 surname: Derraz fullname: Derraz, Imad organization: Department of Neuroradiology, CHU Montpellier, Montpellier, France – sequence: 19 givenname: Ricardo surname: Moreno fullname: Moreno, Ricardo organization: Department of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France – sequence: 20 givenname: Marc surname: Bintner fullname: Bintner, Marc organization: Department of Neuroradiology, CHU de la Réunion, Saint-Denis, France 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surname: Bricout fullname: Bricout, Nicolas organization: Department of Interventional Neuroradiology, CHU Lille, Lille, France – sequence: 33 givenname: Titien surname: Tuilier fullname: Tuilier, Titien organization: Department of Neuroradiology, CHU Henri Mondor, Créteil, France – sequence: 34 givenname: Alexis surname: Guedon fullname: Guedon, Alexis organization: Department of Neuroradiology, CHU Lariboisiere Fernand-Widal, Paris, France – sequence: 35 givenname: Raoul orcidid: 0000-0003-4417-1496 surname: Pop fullname: Pop, Raoul organization: Department of Neuroradiology, CHU Strasbourg, Strasbourg, France – sequence: 36 givenname: Pierre surname: Thouant fullname: Thouant, Pierre organization: Department of Neuroradiology, CHU Dijon, Dijon, France – sequence: 37 givenname: Guillaume surname: Bellanger fullname: Bellanger, Guillaume organization: Department of Neuroradiology, CHU Toulouse, Toulouse, France – sequence: 38 givenname: Riccardo surname: Zannoni fullname: Zannoni, 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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35347058$$D View this record in MEDLINE/PubMed https://univ-fcomte.hal.science/hal-03654643$$DView record in HAL |
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| ContentType | Journal Article Web Resource |
| Contributor | Hanafi, Riyad Testud, Benoit Manceau, Pierre-François Janot, Kevin Chalumeau, Vanessa Drai, Maxime Dargazanli, Cyril Liao, Liang Lefebvre, Margaux Boucherit, Julien Alias, Quentin Bolognini, Federico Duranteau, Jacques Aouni, Mourad Cheddad El Bretzner, Martin Allard, Julien Delvoye, François Papaxanthos, Jean Marnat, Gaultier Spelle, Laurent Darcourt, Jean Hassen, Wagih Ben Mihoc, Dan Sorin Comby, Pierre-Olivier L'Allinec, Vincent |
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| Copyright | Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. 2023 Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. Distributed under a Creative Commons Attribution 4.0 International License |
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| Keywords | Drug Intervention Pharmacology Platelets Standards |
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| Snippet | BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be... Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant... Background Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be... [en] BACKGROUND: Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be... |
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| SubjectTerms | Aneurysms Aspirin Blood platelets Cardiology Cross-Sectional Studies Drug Drug dosages Embolization Fibrinolytic Agents Fibrinolytic Agents - therapeutic use Heparin Heparin - therapeutic use Human health and pathology Human health sciences Humans Intervention Intubation Life Sciences Neurologie Neurology Neurology (clinical) Pharmacology Platelet Aggregation Inhibitors Platelet Aggregation Inhibitors - therapeutic use Platelets Sciences de la santé humaine Stents Stroke Stroke - drug therapy Stroke - etiology Stroke - surgery Surgery Thromboembolism Thrombolytic drugs |
| Title | Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey |
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