Journal of Cerebrovascular Disease 2019 Vol.2 No.1 1-32
Preventive Effect of Perioperative Management Using Oral Clopidogrel on Postoperative Rebleeding in Patients with Spontaneous Intracerebral Hemorrhage
Author(s): Tao Yang1,Zhong-Xiao Lin2,Xi-Lin Zhang3,Xing-Ming Zhong3
1Department of Neurosurgery, Huzhou First People’s Hospital, Huzhou 313000, China
2Department of Neurosurgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
3Central Laboratory, Huzhou First People’s Hospital, Huzhou 313000, China
Corresponding Author: Xing-Ming Zhong
Corresponding email(s): email@example.com
Key Words: Spontaneous intracerebral hemorrhage; Clopidogrel; Adenosine diphosphate; Perioperative management
Background: With the aging society in China and the increasing incidence of cardiovascular and cerebrovascular diseases, spontaneous cerebral hemorrhage with the use of oral clopidogrel has become common in patients. Owing to its inhibition of platelet aggregation, oral clopidogrel results in a high incidence of postoperative intracranial rebleeding, and the prognosis is poor. The purpose of this study is to determine the effect of perioperative management of spontaneous intracerebral hemorrhage (SICH) using oral clopidogrel on postoperative rebleeding.
Methods: From January 2010 to June 2018, 64 patients with SICH who took clopidogrel orally and finally received surgical treatment were selected from Huzhou First People’s Hospital and the Second Affiliated Hospital of Wenzhou Medical University. The influencing factors of postoperative rebleeding were analyzed via a case-control study.
Results: All patients with SICH were divided into two groups according to the standard time of drug withdrawal before surgery: drug withdrawal at < 3 days and ≥ 3 days. The incidence of postoperative rebleeding after drug withdrawal at ≥ 3 days was significantly lower than that after drug withdrawal at < 3 days. Thereafter, all patients were divided into two groups according to the adenosine diphosphate (ADP) inhibition rate detected using a thromboelastography monitor: ADP inhibition rate of < 60% and ≥ 60%. The incidence of postoperative rebleeding in the ADP inhibition rate of < 60% group was significantly lower than that in the ADP inhibition rate of ≥ 60% group. In addition, drug withdrawal at ≥ 3 days and ADP inhibition rate of < 60% had a synergistic effect on the prevention of postoperative rebleeding.
Conclusions: Patients with drug withdrawal at ≥ 3 days can undergo active early surgery. The ADP inhibition rate of ≥ 60% can be used as the predictive index of high-risk postoperative rebleeding in patients with SICH taking oral clopidogrel. By reducing the ADP inhibition rate to < 60%, the incidence of postoperative rebleeding can also be reduced.