Kenji Shoda1, Yukiko Enomoto2, Yusuke Egashira2, Takamasa Kinoshita2, Daisuke Mizutani2, Toru Iwama2. 1. Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan. sho_ken@gifu-u.ac.jp. 2. Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
Abstract
BACKGROUND: Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. METHODS: Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter). RESULTS: From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups. CONCLUSION: Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.
BACKGROUND: Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. METHODS:Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter). RESULTS: From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups. CONCLUSION: Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.
Authors: Matthew J Price; Peter B Berger; Paul S Teirstein; Jean-François Tanguay; Dominick J Angiolillo; Douglas Spriggs; Sanjeev Puri; Mark Robbins; Kirk N Garratt; Olivier F Bertrand; Michael E Stillabower; Michael E Stillablower; Joseph R Aragon; David E Kandzari; Curtiss T Stinis; Michael S Lee; Steven V Manoukian; Christopher P Cannon; Nicholas J Schork; Eric J Topol Journal: JAMA Date: 2011-03-16 Impact factor: 56.272
Authors: Gregg W Stone; Bernhard Witzenbichler; Giora Weisz; Michael J Rinaldi; Franz-Josef Neumann; D Christopher Metzger; Timothy D Henry; David A Cox; Peter L Duffy; Ernest Mazzaferri; Paul A Gurbel; Ke Xu; Helen Parise; Ajay J Kirtane; Bruce R Brodie; Roxana Mehran; Thomas D Stuckey Journal: Lancet Date: 2013-07-26 Impact factor: 79.321
Authors: James D Rossen; Nohra Chalouhi; Shafik N Wassef; Jacob Thomas; Taylor J Abel; Pascal M Jabbour; David K Kung; David M Hasan Journal: J Neurosurg Date: 2012-09-07 Impact factor: 5.115