Use of thromboelastography to tailor dual-antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the Pipeline embolization device

McTaggart, Ryan; Choudhri, Omar; Marcellus, Mary L.; Brennan, Thomas P.; Dodd, Robert; M., Huy; Marks, Michael P.

doi:10.1136/neurintsurg-2013-011089

Cited by 25 publications

(20 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One study found that all patients were among the expected antiplatelet inhibition rate 33. The remaining studies did not report complications based on antiplatelet testing results, but 20 studies reported the action taken after abnormal results: two studies reported postponing procedures,34 35 three reported modification of the loading dose,36–38 eight reported switching to prasugrel/ticagrelor regimens,14 39–45 and seven studies reported switching to an alternative regimen 46–52. Another eight studies (335 patients) did not conduct antiplatelet testing at all and nine studies with 406 patients did not report the data on its usage (table 2).…”

Section: Resultsmentioning

confidence: 99%

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

Podlasek

Sultan

Assis

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundThromboembolic complications are not uncommon in patients undergoing neurointerventional procedures. The use of flow diverting stents is associated with higher risks of these complications despite current dual antiplatelet regimens.ObjectiveTo explore contemporary evidence on the safety of emerging dual antiplatelet regimens in flow diverting stenting procedures.MethodsWe performed a systematic review and meta-analysis to identify relevant articles in electronic databases, and relevant references. Studies reporting the complications and mortality of flow diverting stenting procedures using acetyl salicylic acid (ASA) + ticagrelor or ASA + prasugrel compared with ASA + clopidogrel were included.ResultsOf 452 potentially relevant studies, we identified 49 studies (2526 patients) which reported the safety of ticagrelor or prasugrel for pooled analysis, and five studies (1005 patients) for meta-analysis. The pooled overall mortality in all studies was 2.14%, ischemic complications 6.89%, and hemorrhagic complications 3.68%. The use of ticagrelor or prasugrel was associated with a lower risk of mortality compared with clopidogrel (RR=4.57, 95% CI 1.23 to 16.99; p=0.02). Considering ischemic events, ASA + clopidogrel was as safe as ASA + prasugrel (RR=0.55, 95% CI 0.11 to 2.74; p=0.47) and ASA + ticagrelor (RR=0.74, 95% CI 0.32 to 1.74; p=0.49). ASA +ticagrelor was not associated with a higher risk of hemorrhagic complications (RR=0.92, 95% CI 0.27 to 3.16; p=0.89).ConclusionsEvidence suggests that dual antiplatelet regimens including ticagrelor or prasugrel are safe for patients undergoing flow diversion procedures. Regimens using ticagrelor were associated with better survival than those using clopidogrel in the included studies.

show abstract

Section: Resultsmentioning

confidence: 99%

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

Podlasek

Sultan

Assis

et al. 2019

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…Few studies have explored tailoring antiplatelet therapy via TEG as opposed to PFT, which was reported to be imprecise in the setting of intracranial stenting . One report evaluated 31 patients at a single center who underwent elective PED placement after 7–14 days of aspirin 81–325 mg and clopidogrel 75 mg/day. Thromboelastography was evaluated before PED placement, and 11 hyporesponders to clopidogrel (ADP‐induced platelet inhibition lower than 30%) were identified and given a larger dose of clopidogrel 600 mg or switched to prasugrel.…”

Section: Platelet Function Testing and Thromboelastographymentioning

confidence: 99%

Periprocedural Neuroendovascular Antiplatelet Strategies for Thrombosis Prevention in Clopidogrel‐Hyporesponsive Patients

et al. 2019

View full text Add to dashboard Cite

Patients undergoing neuroendovascular procedures such as cerebral aneurysm coiling and intracranial stent deployment are frequently treated with antiplatelet agents to prevent thrombotic complications. The combination of aspirin and a P2Y12 inhibitor such as clopidogrel is often initiated days before elective procedures or as loading doses for emergent procedures; however, some patients may still experience thrombotic complications. Patients identified as clopidogrel hyporesponders are more likely to experience poor outcomes and may require changes to their regimens. Historically, high‐dose clopidogrel regimens were used in response to subtherapeutic results of platelet function assays and point‐of‐care testing despite limited supporting data. Recently, more data have emerged using alternative P2Y12 inhibitors such as prasugrel and ticagrelor. Dosing for neuroendovascular conditions is often extrapolated from the cardiac literature, although outcomes in cardiac patients may not be relevant to neurologic patients, making prophylactic treatment recommendations challenging for these patients. This review summarizes the literature for antiplatelet prophylaxis in patients undergoing neuroendovascular device placement, focusing on alternative regimens for clopidogrel hyporesponders.

show abstract

“…Abnormal platelet function as identified by PlateletMapping ® was found to predict blood losses after cardiac surgery (Chowdhury et al , ).It was also found to predict blood transfusion in patients taking clopidogrel within 7 days before non‐cardiac surgery (Kasivisvanathan et al , ) and proposed to determine the optimal timing for semi‐urgent surgery in patients still on clopidogrel at hospital admission (Cattano et al , ). In addition, Platelet Mapping ® can possibly identify non‐responder to anti‐platelet agents and some have advocated its use to tailor anti‐platelet therapy after stent placement (McTaggart et al , ). There is no evidence to make such a recommendation and two large trials using other measures of platelet function failed to show any benefit of tailoring anti‐platelet after coronary stent implantation (Price et al , ; Trenk et al , ).…”

Section: Application Of the Viscoelastic Assaysmentioning

confidence: 99%

The place of viscoelastic testing in clinical practice

Hans

Besser

2016

Br J Haematol

View full text Add to dashboard Cite

Hellmut Hartert was the first person to exploit the viscoelastic properties of clotting blood to measure blood coagulation in 1948. Since then, the technology has improved, allowing these analyses to be performed as point-of-care tests with immediately-available results. The addition of several activators and inhibitors to the original assay creates a panel of tests able to quantify the different aspects of blood clotting that can rival conventional laboratory assays. However, although much progress has been made, the standardization and validation of these tests still need improvement. Viscoelastic analyses of blood coagulation are mainly used to guide haemostatic therapy in bleeding patients and have proven superior to standard clotting tests in some circumstances. There is potential to extend their use to other areas, such as drug monitoring, and diagnosis and management of congenital bleeding disorders. The forthcoming cartridge-based assays are expected to improve the reliability and usability of viscoelastic assays of blood coagulation but high quality clinical trials remain urgently needed to determine their exact place, benefit and cost effectiveness.

show abstract

Use of thromboelastography to tailor dual-antiplatelet therapy in patients undergoing treatment of intracranial aneurysms with the Pipeline embolization device

Cited by 25 publications

References 21 publications

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

Periprocedural Neuroendovascular Antiplatelet Strategies for Thrombosis Prevention in Clopidogrel‐Hyporesponsive Patients

The place of viscoelastic testing in clinical practice

Contact Info

Product

Resources

About