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INNOSC Theranostics and
Pharmacological Sciences Antiplatelet treatments in neurological patients

can disrupt the normal flow of blood in the brain . These closely monitored. The administration of antiplatelet and
[4]
vascular anomalies pose a considerable threat of rupture, anticoagulant therapy is a crucial aspect of medical care
which can consequently result in severe neurological that necessitates a personalized approach, contingent on
implications, including the onset of subarachnoid the patient’s symptoms and presentations, as well as the
hemorrhage [4-6] . These challenges have driven the rapid nature of the intervention being executed.
development of vascular devices and surgical techniques, As of recently, the American Heart Association and the
such as flow diversion, non-stent- and stent-assisted coiling American Stroke Association have jointly released a revised
(SAC), and catheter embolization [3,7] , promoting the rapid set of management guidelines for the administration of
evolution of the neurovascular surgery field.
antiplatelet and anticoagulant therapy in patients subjected
Neurovascular disorders pose serious risks to to neurovascular procedures [19,20] . These guidelines cover
heightened morbidity and mortality rates among the a range of topics, including the selection of appropriate
affected patients if such conditions are left uncontrolled, pharmaceutical interventions, the timing of therapy
and thus, the management of these disorders has become initiation and discontinuation, and the management of
an emerging area of concern in the field of neurology bleeding complications [19,20] . Ultimately, the purpose of this
and neurosurgery, which has a bearing on the patients’ document serves to establish a uniform methodology for
quality of life . In essence, the regulation of neurovascular health-care practitioners to administer these treatments,
[6]
diseases is a critical aspect of healthcare that emphasizes with the aim of improving patient outcomes and
the minimization of thromboembolic events while minimizing the likelihood of unfavorable incidents .
[21]
ensuring adequate blood supply to the brain [8-10] . This, in Through dedicated adherence to these guidelines, health-
particular, is a crucial area of research and clinical practice, care professionals can ensure that patients undergoing
as neurovascular conditions can have severe consequences neurovascular interventions will receive optimal care
for patients, such as cognitive impairments and, under and achieve the best possible outcomes. The efficacy and
serious circumstances, even death. To address these clinical safety of these pharmaceutical agents have been rigorously
issues, health-care professionals must employ a range of scrutinized in several studies, which also further
strategies that include not only surgical procedures but highlighted the significant role of these agents in the
also pharmacological interventions. By implementing reduction of adverse outcomes in high-risk patient [22-24] .
these approaches, health-care providers can help improve Therefore, the use of antiplatelet and anticoagulant agents
patient outcomes and reduce the burden of neurovascular remains a cornerstone of modern medical practice, but
manifestations on individuals and society as a whole. most importantly, in the world of neurovascular diseases.
The administration of antiplatelet and anticoagulant
agents is a widely accepted approach to achieving 2. Utility and efficacy of flow diversion
therapeutic goals in patients with neurovascular disorders Flow-diverter devices (FDDs) are an emerging method
(Figure 1). Primarily, these agents are utilized to prevent for treating cerebral aneurysms. As seen in Figure 2, this
the formation of blood clots, which could potentially lead method is performed by placing a stent in the parent
to the development of severe complications, such as stroke, artery where the aneurysm neck is located to disrupt intra-
myocardial infarction, and pulmonary embolism . aneurysmal flow, favoring intra-aneurysmal thrombosis .
[11]
[25]
Antiplatelet agents are widely utilized to prevent thrombus Using this device, the growth of endothelial cells over the
formation by inhibiting platelet aggregation . Of interest, neck of the aneurysm progressively excludes the aneurysm
[12]
aspirin and clopidogrel are two commonly used drugs — sac from circulation .
[26]
efficacious in diminishing the risk for thrombosis [12,13] .
Similarly, anticoagulant agents act by impeding the Specifically, the utilization of FDD promotes flow
coagulation cascade, thereby inhibiting the formation of disruption and formation of a stable blood clot within the
blood clots . Warfarin and heparin are two commonly aneurysm, ultimately contributing to aneurysm occlusion.
[14]
used anticoagulants that clinical studies have shown The endothelization process begins as soon as the FDD is
to be effective in preventing the formation of thrombi deployed, and adhesion of undifferentiated cells occurs
in vascular disease [15-17] . As such, the administration of indiscriminately along the implanted stent [27,28] . Within
antithrombotic agents is of paramount significance in 1 day of implantation, inflammatory cells cluster across the
patients with neurovascular disease, as they are at an aneurysm neck. Compared to coil embolized aneurysms,
increased risk of thromboembolic events [17,18] . However, the the presence of tumor necrosis factor-alpha and monocyte
administration of the pharmacological agents mentioned chemoattractant protein-1 in FDD-treated aneurysms
above necessitates meticulous management, and their suggests that invading inflammatory biological units like
impact on bleeding and thromboembolic events must be macrophages may support healing following implantation

Volume 7 Issue 1 (2024) 2 https://doi.org/10.36922/itps.1202