E-276 Safety of ultra-low dose prophylactic tirofiban: experience across 132 cases

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Introduction/Purpose Current literature reports thromboembolic complications from 5.6 to 27% in endovascular aneurysm treatments, with distal circulation aneurysms often responsible for the higher complication rates. Prophylactic tirofiban has been utilized for platelet inhibition across various neurointerventional procedures to mitigate acute thrombotic events. It is an attractive agent for augmenting platelet inhibition given its short half-life and presence of a reversal agent (DDAVP). While prior studies have reported use of 0.10-μg·kg·min periprocedural tirofiban infusions for acute symptomatic thrombosis with low hemorrhagic complication rates (2.2%), we describe the utilization of ultra-low dose prophylactic tirofiban infusion (1.65 mcg/kg/hr or 0.0275 mcg/kg/min) across various neurointerventional procedures for antithrombotic prophylaxis Materials and Methods We retrospectively reviewed a prospectively maintained database to identify cases in which 1.65 mcg/kg/hr of tirofiban was infused postprocedurally across neurointerventional procedures (flow diversion embolization, carotid stenting). Results From June 2020 to April 2023, a total of 132 cases in 114 patients (mean age 65±1 years, 77% female) were analyzed. Cases included treatment for aneurysm (n = 120), carotid artery stenting (n = 9), stenting for intracranial atherosclerosis (n = 2), and mechanical thrombectomy (n = 1). 101 aneurysm and 2 stenting cases were located in the anterior circulation (76.5%, 18%). Dual antiplatelet regimens were utilized in all cases preoperatively: aspirin/clopidogrel (n=6, 4.5%), aspirin/ticagrelor (n=91, 69%), aspirin/prasugrel (n=14, 11%), aspirin only (n = 4, 3%), or other combination (n=17, 13%). Average PRU was 75.9 ± 6.2, with 50 hyperresponsive PRU cases (45.5%; PRU between 0 and 60), and 35 cases (31.2%) with PRU values between 60 and 120. Tirofiban was utilized as antiplatelet prophylaxis treatment in 31 cases (23.5%) for greater than 12 hours, and for the treatment of thrombotic phenomena in 7 (5.3%) cases. No minor stroke (NIHSS < 4), major stroke (NIHSS >4), hemorrhagic complications, or iatrogenic dissections were reported amongst these cases. There was one neurological death due to delayed thrombotic complication in a large basilar trunk aneurysm. Conclusion Ultra-low dose prophylactic tirofiban is associated with decreased hemorrhagic complications while safely preventing periprocedural thrombotic events across various neurointerventional procedures. Disclosures J. Campos: None. B. Meyer: None. D. Zarrin: None. F. Laghari: None. M. Khan: None. J. Collard de Beaufort: None. A. Ramesh: None. G. Amin: None. T. Bengston: None. N. Beaty: 5; C; proctor, Medtronic Neurovascular, proctor, Stryker Neurovascular, CMO, NeuroMedica. S. Suzuki: None. M. Bender: 5; C; proctor, Stryker Neurovascular. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Rapid Medical, Cerovenus, Stryker Neurovascular. A. Coon: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular, Cerovenus, Rapid Medical, Avail MedSystems, Imperative Care, Deinde, InNeuroCo, Q’apel. 5; C; proctor, Medtronic Neurovascular, proctor, Stryker Neurovascular, proctor, MicroVention-Terumo.

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