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Objective To compare the perioperative complications of prophylactic use of three antiplatelet strategies in unruptured intracranial aneurysms treated by stent assisted coiling.Methods A total of 203 consecutive patients were brought into this retrospective study including the following three groups: the loading group(n=54),with a loading dose of 300 mg to 600 mg clopidogrel at 2 h to 24h before the stenting; tirofiban group(n=50),a loading dosage of tirofiban(8μg/kg/min over 3 min)followed by a 0.1μg/kg/min maintenance dosage; dual antiplatelet group(n=99),dual oral antiplatelet drugs(clopidogrel 75 mg+aspirin 100 mg)pretreated for 3-5 days before the operation.Events of hemorrhage and thromboembolism were recorded and the complications were compared to assess the safety and efficacy of various antiplatelet strategies.Chi-square or Fisher exact tests were used for categorical variables.Results The hemorrhagic rates were 11.1%in loading group,2.0%in dual antiplatelet group,and 0%in tirofiban group,respectively,while the thromboembolic rates were 7.4%in loading group,4.0%in dual antiplatelet group,and 0%in tirofiban group,respectively.For total complications,significant difference(P < 0.05)exists among the three groups,and the complication rate in loading group was significant higher than the dual group(P = 0.016)and tirofiban group(P = 0.001),while between tirofiban group and dual antiplatelet group,there was no significant difference(P > 0.05).The hemorrhagic rate in loading group was significant higher than the dual group(P = 0.023)and tirofiban group(P = 0.027),while between tirofiban group and dual antiplatelet group,there was no significant difference(P > 0.05).In subgroup analysis of the loading group,the postoperative thromboembolic rate was significant higher in those exposed to low molecular weight heparin than those not(P = 0.039)with no increase of hemorrhagic events(P > 0.05).Conclusions When compared with the dual antiplatelet strategy,tirofiban strategy may be a used as a new prophylactic protocol in unruptured intracranial aneurysms treated by stent assisted coiling.Those treated by low molecular weight heparin postoperative after receiving dual antiplatelet therapy may increase the hemorrhagic risk,although there was a significant decrease in thromboembolic events postoperative.