Table 1.
Anticoagulation recommendations for neurointerventional procedures.
| Intraprocedural anticoagulation | Antiplatelet loading dose | Ongoing antiplatelet treatment | |
|---|---|---|---|
| Small neck aneurysm coiling | Heparin bolus of 5000 U, then 1000 U/l continuously during the procedure, with control of ACT (~200) | Nil | Nil |
| Wide neck aneurysm coiling | Heparin bolus 5000 U, then 1000 U/l continuously, with control of ACT ~200 | Nil | Aspirin 100 mg to be continued indefinitely |
| Aneurysm stenting without additional coiling | Heparin bolus 5000 U, then 1000 U/l continuously, with control of ACT ~200 | 3 days before procedure, aspirin 100 mg and clopidogrel 75 mg | Dual-therapy depending on stent-model, with aspirin to be continued indefinitely thereafter |
| Aneurysm stenting + coiling | Heparin bolus 5000 U, then 1000 U/l continuously, with control of ACT ~200 | 3 days before procedure, aspirin 100 mg and clopidogrel 75 mg | Dual-therapy depending on stent-model, with aspirin to be continued indefinitely thereafter |
| Aneurysm balloon-remodeling | Heparin bolus of 5000 U, then 1000 U/l continuously during the procedure, with control of ACT (~200) | Nil | Nil |
| Bare metal stent (BMS) | Heparin bolus 5000 U, then 1000 U/l continuously, with control of ACT ~200 | 3 days before procedure, aspirin 100 mg and clopidogrel 75 mg | Dual-therapy for 3 months, with aspirin to be continued indefinitely thereafter |
| Drug eluting stent (DES) | Heparin bolus 5000 U, then 1000 U/l continuously, with control of ACT ~200 | 3 days before procedure, aspirin 100 mg and clopidogrel 75 mg | Dual-therapy for 1 year, with aspirin to be continued indefinitely thereafter |
| Embolization of AVM/DAVF and tumor | Heparin bolus of 5000 U, then 1000 U/l continuously during the procedure, with control of ACT (~200) | Nil | Nil |