Secondary risks of bleeding and associated outcome after tirofiban application during interventional treatment of intracranial aneurysms.

Introduction: Device-assisted endovascular treatment of ruptured aneurysms may require antiplatelet therapy, but bleeding risk is a concern. This retrospective propensity score-matched cohort study investigated whether tirofiban, including prolonged administration for ≥7 days, was associated with secondary bleeding complications. Methods: We analyzed 99 patients treated endovascularly aSAB between 2006 and 2024, including 51 patients receiving tirofiban and 48 controls selected using propensity score matching. Tirofiban patients were categorized into short-term treatment (<7 days) and prolonged treatment (≥7 days). Bleeding complications were classified using an adapted Heidelberg bleeding classification and categorized as spontaneous or surgery-associated. Results: For the main bleeding endpoints, evaluable data were available for 42 controls, 29 patients with short-term tirofiban, and 18 patients with prolonged tirofiban. Any spontaneous secondary bleeding occurred in 6/42 controls (14%), 2/29 short-term tirofiban patients (7%; p = 0.46), and 1/18 prolonged tirofiban patients (6%; p = 0.66). Surgery-associated bleeding occurred in 13/42 controls (31%), 11/29 short-term tirofiban patients (38%; p = 0.72), and 7/18 prolonged tirofiban patients (39%; p = 0.77). Clinically relevant bleeding occurred in 2/42 controls (5%), 0/29 short-term tirofiban patients (0%; p = 0.51), and 1/18 prolonged tirofiban patients (6%; p = 1.00). Median hospital duration was 21 days in controls, 18 days in short-term, and 31 days in prolonged tirofiban patients. Conclusion: In this small retrospective cohort, tirofiban, including prolonged administration for ≥7 days, was not associated with a statistically significant increase in spontaneous, surgery-associated, or clinically relevant secondary bleeding. These exploratory findings require confirmation in larger prospective studies.