Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

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FIG 1.
Flow chart of the modified DELPHI process as it was used in this study.
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FIG 2.
Summary of panel consensus for antiplatelet management for stent-assisted coiling/flow diversion of ruptured intracranial aneurysms.

Table 1:

Consensus recommendations for the dosage of GPIIb/IIIa receptor inhibitors^18-26

Agent	Tirofiban	Eptifibatide	Abciximab
Loading dose (IV or IA bolus)	12 mcg/kg for30 min^{^a}	180 mcg/kg for 1–2 min	0.25 mg/kg
Maintenance dose (if necessary, IV infusion for 12–24 hours)	0.1 mcg/kg/min	2 mcg/min	0.125 mcg/kg/min
Trade name	Aggrastat	Integrilin	ReoPro
Duration of antiplatelet effect	4–8 hours	4 hours	48 hours

Table 2:

Consensus recommendations for dosing of oral P2Y12 inhibitors in the postprocedural period^24,27

Agent	Clopidogrel^{^a}	Ticagrelor	Prasugrel
Loading dose^{^b}	600 mg	180 mg	40–60 mg
Maintenance dose	75 mg daily	60–90 mg 2×/day	5–10 mg daily
Trade name	Plavix	Brilinta/Brilique	Effient
Onset of action	2 hours	30 min	15–30 min

↵a The panel favored clopidogrel as the oral P2Y12 inhibitor of choice in the postprocedural period after discontinuation of the GPIIb/IIIa inhibitor but acknowledged that in case of known clopidogrel resistance, an alternative P2Y12 inhibitor may be chosen and that evidence from unruptured intracranial aneurysm treatment might suggest a superior safety profile of prasugrel compared with clopidogrel in the acute phase.²⁸ It was thought that in cases in which ticagrelor was administered in the periprocedural period, it could be continued beyond the periprocedural period, depending on the cost and availability of different agents.
↵b If deemed necessary.