Laboratory assessments of therapeutic platelet inhibition in endovascular neurosurgery: complication prediction using the VerifyNow P2Y12 assay and thromboelastography with platelet mapping

Corliss, Brian M.; Freedman, Rachel; Brennan, Meghan; Smith, Jessica; Nerva, John D.; Harris, Neil; Polifka, Adam; Hoh, Brian L.; Fox, W. Christopher

doi:10.3171/2019.12.jns192396

Cited by 14 publications

(5 citation statements)

References 32 publications

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“…Studies have shown that for patients with intracranial stent placement, there is no statistically signi cant difference in MA-ADP between the bleeding event group and the non-bleeding event group. They believe that TEG-PM is almost no predictor of bleeding complications in such patients' roles [19]. Another study also pointed out that TEG parameters were not found to be associated with bleeding complications in patients [20].…”

Section: Discussionmentioning

confidence: 97%

A nomogram to predict the risk of bleeding after discharge from stent-assisted ruptured aneurysm embolization in a Chinese population

et al. 2023

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BackgroundThe occurrence of bleeding events may seriously affect the prognosis of patients with Stent-Assisted Coil (SAC) aneurysms. A nomogram can provide a personalized, more accurate risk estimate based on predictors. We, therefore, developed a nomogram to predict the probability of bleeding events in patients with stent-assisted aneurysm embolization. MethodsWe performed a single-center retrospective analysis of data collected from patients undergoing stentassisted aneurysm embolization between January 2018 and December 2021. Forward stepwise logistic regression was performed to identify independent predictors of adverse events of bleeding after stentassisted embolization and to establish nomograms. Discrimination and calibration of this model using the area under the ROC curve (AUC-ROC) and the calibration plot. The model is internally validated by using resampling (1000 replicates). ResultsA total of 131 patients were collected, and a total of 118 patients met the study criteria. The predictors included in the nomogram were Body Mass Index(BMI), AAi, and MA-ADP. The model showed good resolving power with a ROC area of 0.893 (95% CI: 0.834 ~ 0.952) for this model with good calibration. ConclusionThe nomogram can be used to individualize, visualize and accurately predict the risk probability of bleeding events after stent-assisted embolization of aneurysms.

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Section: Discussionmentioning

confidence: 97%

A nomogram to predict the risk of bleeding after discharge from stent-assisted ruptured aneurysm embolization in a Chinese population

et al. 2023

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“…VerifyNow quanti es platelet inhibition % induced by antiplatelet therapy. Nevertheless, VerifyNow does not provide information pertaining to other aspects of platelet function, such as clot formation kinetics [19]. PFA-200 assesses primarily primary hemostasis and platelet adhesion, yet it lacks the comprehensive evaluation of clot formation and brinolysis offered by TEG [20].…”

Section: The Comparison Of Platelet Function Testing Methodsmentioning

confidence: 99%

Role and Clinical Significance of Thromboelastography-Guided Individualized Antiplatelet Therapy in Non-cardiogenic Ischemic Stroke: A Retrospective Cohort Study

Zhang

Wang

2023

Preprint

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This study examined the impact of individualized antiplatelet (IA) therapy guided by Thromboelastography (TEG) in non-cardiogenic ischemic stroke patients. The patients were divided into an IA group and a control group receiving conventional treatment. A one-year follow-up tracked mortality, bleeding events, and ischemic events. 715 patients were initially enrolled, with 684 meeting the inclusion criteria (487 in IA group, 197 in control group). IA therapy significantly reduced the composite rate of death, bleeding, or ischemic events compared to conventional therapy (7.39% vs. 15.74%, P = 0.001). The IA group showed a lower incidence of combined bleeding or ischemic events (6.98% vs. 15.32%, P = 0.001). Furthermore, the IA group had lower rates of ischemic stroke (2.46% vs. 5.58%, P = 0.04) and myocardial infarction (3.08% vs. 6.6%, P = 0.035) compared to the control group. Cox regression analysis revealed that age (hazard ratio, 1.043; 95% CI, 1.01-1.078, P = 0.011) and coronary artery disease (hazard ratio, 1.902; 95% CI, 1.147-3.153, P = 0.013) were associated with increased risk of adverse events compared to the control group. A therapy guided by platelet function testing can effectively reduce adverse events, particularly the risk of ischemic events, in the clinical prognosis of ischemic stroke. However, Caution is needed in IA therapy for elderly and coronary heart disease patients due to potential risks. Further large-scale experiments are required to validate and optimize personalized antiplatelet therapy in this population. Trial Registration clinicaltrials.gov Identifier: NCT 03471169

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“…Only TEG-PM could not predict thrombotic events or even bleeding complications through neurosurgical procedures [ 173 ]; however, it showed good ability in the prediction of platelet inhibition in comparison to other modalities [ 165 ].…”

Section: Reviewmentioning

confidence: 99%

Thromboelastography in the Perioperative Period: A Literature Review

Ramanujam¹,

DiMaria²,

Varma³

2023

Cureus

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Assessing coagulation status is essential for prompt intervention to reduce morbidity and mortality related to bleeding and thrombotic complications during the perioperative period. Traditional coagulation tests such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), and activated clotting time (ACT) provide only static evaluation. These tests are not designed for assessment of dynamically changing coagulation conditions during the perioperative time. However, viscoelastic coagulation testing such as thromboelastography (TEG) produces a rapid numerical and graphical representation that helps to detect and direct targeted hemostatic therapy. Searching the literature through PubMed, Medline, Ovid, CINAHL, and ClinicalTrials.gov we retrieved 210 studies, which represent the use of TEG in the perioperative period. The included studies were categorized under various settings such as trauma, obstetrics, orthopedics, intensive care unit (ICU), cardiovascular, transplant, and miscellaneous scenarios. TEG showed promising results in trauma surgeries in predicting mortality, hypercoagulability, and bleeding even when it was compared to conventional methods. TEG was also useful in monitoring anticoagulant therapy in orthopedic and obstetric surgeries; however, its role in predicting thrombotic events, hypercoagulability, or complications was questionable. In ICU patients, it showed promising results, especially in the prediction or improvement of sepsis, coagulopathy, thrombotic events, ICU duration, hospital stay, and ventilator duration. TEG parameters effectively predicted hypercoagulation in transplant surgeries. Regarding cardiovascular surgeries, they were effective in the prediction of the need for blood products, coagulopathy, thrombotic events, and monitoring anticoagulation therapy. More randomized clinical trials comparing TEG parameters with standardized tools are needed to produce robust results to standardize its use in different perioperative settings.

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Laboratory assessments of therapeutic platelet inhibition in endovascular neurosurgery: complication prediction using the VerifyNow P2Y12 assay and thromboelastography with platelet mapping

Cited by 14 publications

References 32 publications

A nomogram to predict the risk of bleeding after discharge from stent-assisted ruptured aneurysm embolization in a Chinese population

A nomogram to predict the risk of bleeding after discharge from stent-assisted ruptured aneurysm embolization in a Chinese population

Role and Clinical Significance of Thromboelastography-Guided Individualized Antiplatelet Therapy in Non-cardiogenic Ischemic Stroke: A Retrospective Cohort Study

Thromboelastography in the Perioperative Period: A Literature Review

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