Raghav Gupta1, Justin M Moore1, Christoph J Griessenauer1, Nimer Adeeb1, Apar S Patel1, Roy Youn2, Karen Poliskey2, Ajith J Thomas1, Christopher S Ogilvy3. 1. Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. 2. Walgreen Company, Illinois, Chicago, USA. 3. Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: cogilvy@bidmc.harvard.edu.
Abstract
INTRODUCTION: Flow diversion with the Pipeline Embolization Device (PED) currently is adopted for treatment of a variety of intracranial aneurysms. The elevated risk of thromboembolic complications associated with the device necessitates the need for administration of antiplatelet agents. We sought to assess current dual-antiplatelet therapy practices patterns and their associated costs after PED placement. MATERIALS AND METHODS: An online questionnaire that assessed dual-antiplatelet regimens after flow diversion for treatment of intracranial aneurysms was developed and disseminated to 80 neurosurgeons at major academic cerebrovascular centers. Pricing information from 2 of the largest prescription payers in Massachusetts was used to calculate the monthly cost of these agents. RESULTS: Twenty-six responses (32.5%) were received. All respondents (100%) affirmed using clopidogrel and aspirin dual-antiplatelet therapy as a first-line regimen. Twenty-three (88.5%) routinely use platelet function testing. Eleven respondents (42.3%) each identified that they administer aspirin/ticagrelor and aspirin/prasugrel to clopidogrel hypo- or nonresponders. For uninsured patients, prasugrel was found to have the highest cumulative monthly cost ($471), followed by ticagrelor ($396), clopidogrel ($149), and ticlopidine ($110). CONCLUSIONS: Significant heterogeneity in dual-antiplatelet regimens after PED placement and associated costs exists at major academic neurovascular centers. The most commonly used first-line dual-antiplatelet regimen consists of aspirin and clopidogrel. Two major alternate protocols involving ticagrelor and prasugrel are administered to clopidogrel hyporesponders. The optimal dual-antiplatelet regimen for patients with cerebrovascular conditions has not been established, given limited prospective data within the neurointerventional literature. Copyright Â
INTRODUCTION: Flow diversion with the Pipeline Embolization Device (PED) currently is adopted for treatment of a variety of intracranial aneurysms. The elevated risk of thromboembolic complications associated with the device necessitates the need for administration of antiplatelet agents. We sought to assess current dual-antiplatelet therapy practices patterns and their associated costs after PED placement. MATERIALS AND METHODS: An online questionnaire that assessed dual-antiplatelet regimens after flow diversion for treatment of intracranial aneurysms was developed and disseminated to 80 neurosurgeons at major academic cerebrovascular centers. Pricing information from 2 of the largest prescription payers in Massachusetts was used to calculate the monthly cost of these agents. RESULTS: Twenty-six responses (32.5%) were received. All respondents (100%) affirmed using clopidogrel and aspirin dual-antiplatelet therapy as a first-line regimen. Twenty-three (88.5%) routinely use platelet function testing. Eleven respondents (42.3%) each identified that they administer aspirin/ticagrelor and aspirin/prasugrel to clopidogrel hypo- or nonresponders. For uninsured patients, prasugrel was found to have the highest cumulative monthly cost ($471), followed by ticagrelor ($396), clopidogrel ($149), and ticlopidine ($110). CONCLUSIONS: Significant heterogeneity in dual-antiplatelet regimens after PED placement and associated costs exists at major academic neurovascular centers. The most commonly used first-line dual-antiplatelet regimen consists of aspirin and clopidogrel. Two major alternate protocols involving ticagrelor and prasugrel are administered to clopidogrel hyporesponders. The optimal dual-antiplatelet regimen for patients with cerebrovascular conditions has not been established, given limited prospective data within the neurointerventional literature. Copyright Â
Authors: J A Larco; M Abbasi; Y Liu; D Dai; G Lanzino; L E Savastano; H Cloft; D F Kallmes; R Kadirvel; W Brinjikji Journal: AJNR Am J Neuroradiol Date: 2021-12-16 Impact factor: 3.825
Authors: Justin E Vranic; Pablo Harker; Christopher J Stapleton; Robert W Regenhardt; Adam A Dmytriw; Naif M Alotaibi; Rajiv Gupta; Thabele M Leslie-Mazwi; Matthew J Koch; Scott B Raymond; Justin R Mascitelli; T Tyler Patterson; Joshua Seinfeld; Andrew White; David Case; Christopher Roark; Chirag D Gandhi; Fawaz Al-Mufti; Jared Cooper; Aman B Patel Journal: Neuroradiol J Date: 2021-11-07
Authors: Jodi R DeGrote; Elizabeth M Olafson; Alexander Drofa; Evgueni Kouznetzov; Michael Manchak; Nathan D Leedahl; David D Leedahl Journal: Can J Hosp Pharm Date: 2018-12-31
Authors: Pouya Entezami; Devin N Holden; Alan S Boulos; Alexandra R Paul; Nicholas C Field; Emad Nourollahzadeh; Junichi Yamamoto; John C Dalfino Journal: Interv Neuroradiol Date: 2020-07-01 Impact factor: 1.610
Authors: K Y Park; T Ozaki; A Kostynskyy; H Kortman; A Hilario; P Nicholson; R Agid; T Krings; V M Pereira Journal: AJNR Am J Neuroradiol Date: 2021-07-08 Impact factor: 4.966