The Roles and Issues of P2Y12 Percent Inhibition Assessed by VerifyNow Assay for Patients Undergoing Neurointervention: A Prospective Study

Kashiwazaki, Daina; Kuwayama, Naoya; Akioka, Naoki; Hayakawa, Yumiko; Kuroda, Satoshi

doi:10.1016/j.jstrokecerebrovasdis.2014.04.014

Cited by 24 publications

(25 citation statements)

References 16 publications

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“…Kang et al and Nishi et al found cutoff values for ischemic and bleeding events, respectively, but the specificity and sensitivity were low. 33,44 Goh et al and Kashiwazaki et al found similar cutoff values for major bleeding events with high sensitivity and specificity, 22,34 but the clinical application of P2Y12 percentage inhibition in assessing antiplatelet therapy remains controversial. This is primarily due to the lack of association between P2Y12 percentage inhibition and clinical outcomes, 33 the inability to make the P2Y12 percentage inhibition correspond with PRU, and the dependence of P2Y12 percentage inhibition on a patient's baseline platelet function value.…”

Section: Platelet Function Testsmentioning

confidence: 96%

“…There are 4 studies utilizing receiver operating characteristic analyses to identify optimal cutoffs for best predicting thromboembolic and bleeding events based on platelet function analysis (Table 1). 22,33,34,44 Each of these studies used VerifyNow with the cutoff values established using either PRUs or P2Y12 percentage inhibition. Kang et al and Nishi et al found cutoff values for ischemic and bleeding events, respectively, but the specificity and sensitivity were low.…”

Section: Platelet Function Testsmentioning

confidence: 99%

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Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Kim

Fraser

Grupke³

et al. 2018

Journal of Neurosurgery

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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.

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Section: Platelet Function Testsmentioning

confidence: 96%

Section: Platelet Function Testsmentioning

confidence: 99%

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Kim

Fraser

Grupke³

et al. 2018

Journal of Neurosurgery

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show abstract

“…In most previous studies that demonstrated the association of platelet reactivity with thromboembolic events, the investigators quoted PRU thresholds that were used to predict cardiovascular outcomes in coronary intervention (2,5,(9)(10)(11)(12)(13), although target diseases for coronary and neurointerventional procedures may be different (14,15). In several previous studies, investigators suggested PRU thresholds for prediction of thromboembolic events in neurointerventional procedures by using retrospective data (4,16,17), but none has been validated in subsequent prospective studies (14). Therefore, the PRU threshold for selecting the modified antiplatelet preparation remains unclear.…”

Section: Patientsmentioning

confidence: 99%

P2Y₁₂ Reaction Units Threshold for Implementing Modified Antiplatelet Preparation in Coil Embolization of Unruptured Aneurysms: A Prospective Validation Study

Kim¹,

Hwang²,

Kwon³

et al. 2017

Radiology

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Purpose To identify and apply an optimized P2Y reaction units (PRU) threshold for implementing modified antiplatelet preparation to prevent thromboembolic events in patients nonresponsive to clopidogrel (clopidogrel nonresponders) undergoing coil embolization of unruptured aneurysms and to evaluate the clinical validity. Materials and Methods The optimal PRU threshold for prediction of thromboembolic events was determined with the Youden index in post hoc analysis of a previous, prospectively enrolled cohort of 165 patients in whom the antiplatelet regimen was not modified. This optimal PRU threshold was used to define clopidogrel nonresponders in a prospective validation study of 244 patients. Standard preparation (aspirin, clopidogrel) was maintained for 126 patients responsive to clopidogrel (clopidogrel responders, 51.6%), and modified preparation (aspirin, prasugrel) was prescribed prior to embolization for 118 clopidogrel nonresponders (48.4%). Fifty-seven clopidogrel nonresponders from the previous cohort who did not receive the modified preparation were included as a historical control group. Thromboembolic and bleeding events were compared among groups by using logistic regression analysis. Results Post hoc analysis from the previous cohort yielded PRU of at least 220 as the optimal threshold for modified preparation selection. The thromboembolic event rate of the clopidogrel responders (one of 126 [0.8%]) was lower than that of the historical control group that received standard preparation (seven of 57 patients [12.3%]; adjusted risk difference [RD], -10.1%; 95% confidence interval [CI]: -18.5, -1.7; P = .015) and was similar to that of clopidogrel nonresponders who received modified preparation (one of 118 [0.8%]; adjusted RD, -0.5%; 95% CI: -3.1, 2.1; P = .001 for noninferiority; P = .699 for superiority). Bleeding event rates did not differ among groups (four of 126 clopidogrel responders [3.2%] vs four of 57 clopidogrel nonresponders that received standard preparation [7.0%] [adjusted RD, -4.5%; 95% CI: -11.1, 3.4; P = .228] vs five of 118 clopidogrel nonresponders that received modified preparation [4.2%] [adjusted RD, -0.6%; 95% CI: -5.8, 4.2; P = .813]). Conclusion Patients undergoing coil embolization of unruptured aneurysms, regardless of clopidogrel responsiveness, had low thromboembolic risk when using PRU of at least 220 as the threshold for implementing modified antiplatelet preparation with prasugrel. RSNA, 2016 Online supplemental material is available for this article.

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“…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

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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.

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The Roles and Issues of P2Y12 Percent Inhibition Assessed by VerifyNow Assay for Patients Undergoing Neurointervention: A Prospective Study

Cited by 24 publications

References 16 publications

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

P2Y₁₂ Reaction Units Threshold for Implementing Modified Antiplatelet Preparation in Coil Embolization of Unruptured Aneurysms: A Prospective Validation Study

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

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The Roles and Issues of P2Y12 Percent Inhibition Assessed by VerifyNow Assay for Patients Undergoing Neurointervention: A Prospective Study

Cited by 24 publications

References 16 publications

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

Management of antiplatelet therapy in patients undergoing neuroendovascular procedures

P2Y12 Reaction Units Threshold for Implementing Modified Antiplatelet Preparation in Coil Embolization of Unruptured Aneurysms: A Prospective Validation Study

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

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P2Y₁₂ Reaction Units Threshold for Implementing Modified Antiplatelet Preparation in Coil Embolization of Unruptured Aneurysms: A Prospective Validation Study