Fatal Thrombosis of a Flow Diverter due to Ibuprofen-related Antagonization of Acetylsalicylic Acid

Excerpt

The use of flow diverters (FD) became well established for the treatment of fusiform and selected sidewall intracranial aneurysms [1]. Even though flow diversion is relatively safe and efficacious, it is not without potential complications. They include ischemic and hemorrhagic events [2]. One of the critical aspects of this technique is the required pre- and postprocedural dual platelet function inhibition. The postprocedural medication protocol following a FD implantation has two main goals: achieving an adequate level of platelet activity inhibition and reducing the inflammatory reaction in the aneurysmal wall [3, 4]. Therefore, we included in our protocol the dual antiplatelet therapy (in this case aspirin and ticagrelor) combined with ibuprofen and steroids to mitigate thrombus-related inflammation. A potential interference of ibuprofen with the antiaggregation effect of aspirin has been described [5]. Given the widespread use of these two drugs, this pharmacological interaction should be taken into account after an intracranial FD implantation. …