Relationship between low response to clopidogrel and periprocedural ischemic events with coil embolization for intracranial aneurysms

Asai, Takumi; Miyachi, Shigeru; Izumi, Tohru; Matsubara, Noriaki; Haraguchi, Kenichi; Yamanouchi, Takashi; Ota, Kohei; Shintai, Kazunori; Tajima, Hirotaka; Wakabayashi, Toshihiko

doi:10.1136/neurintsurg-2015-011727

Cited by 36 publications

(29 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In emergency neuroendovascular interventions in which preprocedure aspirin therapy is not possible, loading doses have varied from 200 to 650 mg. Based on various laboratory definitions for HTPR, the incidence of aspirin hyporesponsiveness varied from 2.1% to 13.5%. 5,17,20,36,47,53 Prabhakaran et al found a strong, inverse relationship between preprocedural weekly aspirin dose and ARUs, in which lower aspirin doses were associated with higher ARUs. 53 Their findings suggest that aspirin should be given at a dose of at least 100 mg daily to maintain ARUs ≤ 550.…”

Section: Aspirinmentioning

confidence: 99%

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Kim

Fraser

Grupke³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

Neuroendovascular techniques for treating cerebral aneurysms and other cerebrovascular pathology are increasingly becoming the standard of care. Intraluminal stents, aneurysm coils, and other flow diversion devices typically require concomitant antiplatelet therapy to reduce thromboembolic complications. The variability inherent with the pharmacodynamic response to common antiplatelet agents such as aspirin and clopidogrel complicates optimal selection of antiplatelet agents by clinicians. This review serves to discuss the literature related to antiplatelet use in neuroendovascular procedures and provides recommendations for clinicians on how to approach patients with variable response to antiplatelet agents, particularly clopidogrel.

show abstract

Section: Aspirinmentioning

confidence: 99%

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Kim

Fraser

Grupke³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

show abstract

“…Inhibition percentage of PRU was defined variously as percent inhibition as less than 20% in three studies, less than 26% in one study, and less than 40% in three studies. Inhibition value of PRU was also defined variously as more than 175 28) , 180 38) , 213 19) , 220 23) , 230 2) , 240 35) , and 285 20) in each study. Very high inhibition level of PRU was defined as percent inhibition of more than 74% 21) in one study and less than 120 38) of PRU value in one study.…”

Section: Resultsmentioning

confidence: 99%

The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysis

Kim

Park

et al. 2020

J Korean Neurosurg Soc

View full text Add to dashboard Cite

The efficacy of P2Y12 reaction unit (PRU) of VerifyNow still remains as a controversial issue in neurointervention. So we investigated the usefulness of PRU of VerifyNow to predict the peri-procedural thromboembolic events (TE) and hemorrhagic events (HE). And we evaluated the safety of modified dual antiplatelet therapy (DAPT) or triple antiplatelet therapy (TAPT) for clopidogrel hyporesponders. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus on August 19 2018. Data was collected the 1) incidence of TE between clopidogrel responder and clopidogrel hypo-responder, 2) incidence of HE between clopidogrel hyper-responder and clopidogrel responder and hypo-responder, and 3) incidence of TE and HE between modified DAPT or TAPT and standard DAPT in clopidogrel hypo-responder. High cutoff value of PRU was defined as PRU >40% or <220. Fifteen studies were enrolled. Clopidogrel responder showed lower incidence of TE than hypo-responder (risk ratio [RR], 0.32; 95% confidence interval [CI], 0.17-0.61; p<0.001). With the high cutoff value of PRU, clopidogrel responder showed more lower incidence of TE than hypo-responder (RR, 0.11; 95% CI, 0.02-0.45; p=0.002). The incidence of periprocedural HE have higher on clopidogrel hyper-responder than clopidogrel responder and hypo-responder (RR, 4.26; 95% CI, 1.10-16.44; p=0.04; I 2 =66%). The incidence of periprocedural TE after changing regimen of DAPT for clopidogrel hypo-responder have a tendency to reduce, but there was no significant difference between modified DAPT or TAPT group and standard DAPT group (p>0.05). The incidence of periprocedural HE after changing regimen of DAPT for clopidogrel hypo-responder was no significant difference between modified DAPT or TAPT group and standard DAPT group (p>0.05). PRU is a useful tool as a predictor of peri-procedural TE or HE on neurointervention. PRU has a threshold effect of cutoff value to predict the peri-procedural TE. Modified DAPT or TAPT to prevent TE in clopidogrel hypo-responders could not reduce the incidence of TE. We should investigate the further research about modification of regiment on neurointervention.

show abstract

“…[17][18][19] In the neurointerventional field, a series of studies since the first publication in this field in 2010 have demonstrated the association between antiplatelet drug resistance and periprocedural ischemic events in reference to endovascular treatment of intracranial aneurysms. 10,[13][14][15][19][20][21] Kang et al 10 showed that procedure-related thromboembolic events occurred more frequently in patients with higher PRU, especially in the fourth quartile. Furthermore, in a randomized clinical trial, modification of antiplatelet treatment based on the functional assay provided benefit in terms of thromboembolic event rate.…”

Section: Antiplatelet Resistance and Coil Embolization Of Unruptured mentioning

confidence: 99%

“…[10][11][12][13] Some reports have demonstrated higher numbers of acute ischemic lesions in patients with CPG resistance. 14,15 Recently, a new generation of P2Y12 adenosine diphosphatereceptor antagonists has been developed. One such drug is prasugrel (PSG).…”

mentioning

confidence: 99%

Prophylactic Antiplatelet Medication in Endovascular Treatment of Intracranial Aneurysms: Low-Dose Prasugrel versus Clopidogrel

Ha¹,

Cho²,

Kim³

et al. 2016

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

Relationship between low response to clopidogrel and periprocedural ischemic events with coil embolization for intracranial aneurysms

Abstract: Low response to clopidogrel had little effect on clinical outcome although it increased asymptomatic large ischemic lesions in this cohort.

Cited by 36 publications

References 26 publications

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysis

Prophylactic Antiplatelet Medication in Endovascular Treatment of Intracranial Aneurysms: Low-Dose Prasugrel versus Clopidogrel

Contact Info

Product

Resources

About