Ticagrelor (n=50) showed no difference in thromboembolic or hemorrhagic complications compared to clopidogrel (n=53) in patients undergoing aneurysm flow diversion, but was more expensive.
Cohort (n=103)
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Does ticagrelor improve safety, efficacy, and cost compared to clopidogrel in patients undergoing aneurysm flow diverter procedures?
Ticagrelor is a safe and effective alternative to clopidogrel for preventing thromboembolic complications after flow diverter deployment, but its higher cost suggests it should be reserved for clopidogrel-hyporesponsive patients.
BACKGROUND: Thromboembolic and hemorrhagic complications are among the most feared adverse events in the endovascular treatment of aneurysms, and this is particularly the case for flow diverter devices. Dual antiplatelet therapy has become standard of care; however, the safety, efficacy, and cost profiles of newer antiplatelet agents are not well characterized in the neurovascular context. OBJECTIVE: To compare the safety, efficacy, and cost of one of these newer agents, ticagrelor, to the most frequently used agent, clopidogrel. METHODS: A multicenter, retrospective, cohort comparison study design of consecutively treated aneurysms with flow diverter embolization device and treated with either ticagrelor or clopidogrel was performed. Data were collected on patient demographics and risk factors, procedural details, antiplatelet treatment regime, complications, and angiographic and functional outcomes. RESULTS: Fifty patients undergoing flow diverter device deployment and treatment with ticagrelor were compared to 53 patients undergoing flow diversion and treatment with clopidogrel. The patients' age, sex, smoking status, aneurismal morphology and size, and procedural details did not differ between the 2 groups; neither did the rate of thromboembolic and hemorrhagic complications, angiographical, and functional outcomes. Ticagrelor was more expensive when compared to clopidogrel. CONCLUSION: Ticagrelor is a safe and effective agent for prevention of thromboembolic complications following flow diverter deployment when compared to clopidogrel. However, ticagrelor remains significantly more expensive than clopidogrel, and, thus, we would advise ticagrelor be reserved for patients who are hyporesponsive to clopidogrel.
Moore et al. (Fri,) conducted a cohort in Aneurysms (n=103). Ticagrelor vs. Clopidogrel was evaluated on Thromboembolic and hemorrhagic complications, angiographical, and functional outcomes. Ticagrelor (n=50) showed no difference in thromboembolic or hemorrhagic complications compared to clopidogrel (n=53) in patients undergoing aneurysm flow diversion, but was more expensive.