What is the optimal management of antiplatelet therapy to mitigate complications in patients undergoing flow diversion?
This review highlights the evolving strategies for antiplatelet therapy in flow diversion, noting comparable efficacy between ticagrelor and clopidogrel and the potential utility of platelet function testing to balance thrombotic and hemorrhagic risks.
Dual antiplatelet therapy is typically employed as a means to mitigate thromboembolic complications after deployment of flow diverters, most commonly consisting of aspirin with either clopidogrel, prasugrel, or ticagrelor. Recent studies have demonstrated at least similar efficacy for ticagrelor as compared to clopidogrel in the form of periprocedural complications and angiographic results. Though controversial, systematic reviews of platelet function assay usage have demonstrated greater rates of thrombotic complications in antiplatelet hyporesponders and greater rates of hemorrhagic complications in hyperresponders. Though in its infancy, the management of antiplatelet therapy for acutely ruptured aneurysms treated with flow diversion is not yet standardized, with approaches including intravenous glycoprotein IIb-IIIa inhibitors and subsequent antiplatelet loading vs antiplatelet loading, response assessment, and subsequent treatment.
Tonetti et al. (Wed,) studied this question.