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. 2019 Jul 15;59(7):247-256.
doi: 10.2176/nmc.st.2018-0265. Epub 2019 May 9.

Changing Paradigms of Periprocedural Antithrombotic Therapy in Neuroendovascular Therapy: Analysis of JR-NET 3

Yukiko Enomoto  1 , Daisuke Mizutani  1 , Shinichi Yoshimura  2 , Nobuyuki Sakai  3 ; Japanese Registry of Neuroendovascular Therapy (JR-NET) investigators
Affiliations

Changing Paradigms of Periprocedural Antithrombotic Therapy in Neuroendovascular Therapy: Analysis of JR-NET 3

Yukiko Enomoto et al. Neurol Med Chir (Tokyo). .

Abstract

To evaluate the changing paradigms of periprocedural antithrombotic management in neuroendovascular therapy in Japan, we analyzed the details of the current periprocedural antithrombotic therapy and compared it with those of the previous generations. We retrospectively analyzed the data from the Japanese Registry of Neuroendovascular Therapy (JR-NET) 3, a nationwide survey in Japan for neuroendovascular therapy between January 2010 and December 2014. A total of 26,233 patients underwent endovascular treatments to usually perform periprocedural antithrombotic therapy were retrospectively analyzed. We compared the results of JR-NET 3 with those of JR-NET 1 (January 2005 and December 2007) and JR-NET 2 (January 2008-December 2009). Post-procedural anticoagulant therapy was less utilized in JR-NET 3 than in JR-NET 2 (53.9% vs. 60.6%, P <0.001). Pre-procedural antiplatelet therapy became more frequent and more intensive with each generation. The frequency of aggressive therapy (dual, and triple or more therapy) was 65.2% in JR-NET 3, which was significantly higher than that of JR-NET 1 and JR-NET 2 (41.5% and 61.2%, respectively, P <0.001). However, periprocedural ischemic complications (2.0% vs. 5.8%, P <0.001) significantly increased, despite aggressive antiplatelet therapy. Neuroendovascular periprocedural antithrombotic therapy is focused more on antiplatelet therapy than on anticoagulant therapy. Currently, antiplatelet therapy is more frequently used with a larger number of multiple agents, however, periprocedural ischemic complications significantly increased.

Keywords: anticoagulant; antiplatelet; neuroendovascular therapy.

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Conflict of interest statement

Conflicts of Interest Disclosure

All authors who are members of Japan Neurosurgical Society (JNS) have declared COI by online-self-reported COI disclosure statement forms to the JNS office through website every year. We have no COI related to this study.

This study was supported in part by a Grant-in-Aid (Junkanki-Kaihatsu H24-4-3) from the National Cerebral and Cardiovascular Center, Japan and by Hatazaki Foundation, Kobe, Japan.

Figures

Fig. 1
Fig. 1
Changes in post-procedural anticoagulant therapy paradigms between JR-NET 2 and 3. (A) The proportion of patients who received post-procedural anticoagulants therapy. (B) The proportion of each anticoagulant used for the patients. AC: anti-coagulants, JR-NET: Japanese Registry of Neuroendovascular Therapy. *P <0.05, **P <0.01.
Fig. 2
Fig. 2
Change in pre- and post-procedural antiplatelet therapy paradigms between JR-NET 1, 2, and 3. (A) The proportion of patients who received pre-procedural antiplatelet therapy. (B) The proportion of patients who received post-procedural antiplatelet therapy. JR-NET: Japanese Registry of Neuroendovascular Therapy.
Fig. 3
Fig. 3
Changes seen in the periprocedural complications in endovascular therapy to usually perform antithrombotic therapy between JR-NET 2 and 3. JR-NET: Japanese Registry of Neuroendovascular Therapy. **P <0.01.
See this image and copyright information in PMC

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