From the Research
Anticoagulation Therapy after Cerebral Aneurysm Coiling
- The optimal anticoagulation therapy after cerebral aneurysm coiling is not well established, but several studies provide insights into the management of anticoagulation and antiplatelet therapy in this setting 1, 2, 3, 4, 5.
- A study published in 2011 found that early heparinization was associated with a lower incidence of microembolic signals (MESs) after coiling of unruptured cerebral aneurysms, suggesting that heparin may be beneficial in preventing thromboembolic events 1.
- Another study published in 2023 found that patients taking oral anticoagulants and antiplatelet drugs experienced more cerebrovascular events after endovascular treatment (EVT) for unruptured cerebral aneurysms, and that direct oral anticoagulants (DOACs) may be more beneficial than vitamin K antagonists (VKAs) in preventing stroke occurrences after EVT 2.
- A retrospective study published in 2023 found that anticoagulant and antiplatelet use in the setting of flow diversion or stent-assisted coiling may carry increased risks as compared to historical norms, and that the use of oral anticoagulation with the addition of antiplatelets may increase the risk of serious bleeding events 3.
- A study published in 2025 found that continuing dual antiplatelet therapy (DAPT) for more than 42 days after stent-assisted coiling (SAC) of unruptured aneurysms did not reduce the risk of thrombotic complications or in-stent stenosis, and that the risk of additional hemorrhagic complications remained low 4.
- A study published in 2013 found that the placement of external ventricular drains (EVDs), intracranial pressure (ICP) gauges, or combined EVD and ICP gauges within 48 hours after coil embolization of cerebral aneurysms under anticoagulation or antiplatelet therapy did not appear to increase the risk of hemorrhages compared to literature 5.
Management of Anticoagulation and Antiplatelet Therapy
- The management of anticoagulation and antiplatelet therapy after cerebral aneurysm coiling should be individualized based on the patient's underlying condition, the type of procedure performed, and the risk of thromboembolic and hemorrhagic complications 1, 2, 3, 4, 5.
- The use of heparin, antiplatelet agents, and oral anticoagulants should be carefully considered, and the patient's response to these medications should be closely monitored 1, 2, 3, 4, 5.
- The duration of DAPT after SAC of unruptured aneurysms may not need to be extended beyond 42 days, as longer duration DAPT did not reduce the risk of thrombotic complications or in-stent stenosis, and the risk of additional hemorrhagic complications remained low 4.