Key result
Tailored dual antiplatelet therapy based on PRU significantly reduced 30-day thromboembolic complications compared to a non-tailored approach (6.6% vs 16%; HR 0.3, 95% CI 0.11-0.81).
Why the study?
Clopidogrel poor response is a risk factor for thromboembolic complications during endovascular treatment of unruptured aneurysms, prompting assessment of a stratified approach using prasugrel.
Does tailored dual antiplatelet therapy based on PRU testing reduce thromboembolic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms?
Cohort (n=217)
Does tailored dual antiplatelet therapy based on PRU testing reduce thromboembolic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms?
Hazard Ratio: 0.3 (95% CI 0.11–0.81)
Absolute Event Rate: 6.6% vs 16%
p-value: p=0.017
Tailoring dual antiplatelet therapy with PRU testing to switch clopidogrel non-responders to prasugrel significantly reduces thromboembolic complications in endovascular treatment of unruptured cerebral aneurysms.
Tailored DAPT was associated with fewer thromboembolic events; hypothesis-generating and should not yet change practice.
BACKGROUND: Thromboembolic complications (TECs) are frequent during the endovascular treatment of unruptured aneurysms. To prevent TECs, dual antiplatelet therapy using aspirin and clopidogrel is recommended for the perioperative period. In patients with a poor response, clopidogrel is a risk factor for TECs. To prevent TECs, our study assessed the stratified use of prasugrel. METHODS: Patients who underwent endovascular therapy for unruptured cerebral aneurysms from April 2017 to August 2019 were enrolled in this clinical study and given premedication with aspirin and clopidogrel for 2 weeks prior to the procedure. P2Y12 reaction units (PRU) were measured using the VerifyNow assay on the day before the procedure (tailored group). In subgroups with PRU <240, the clopidogrel dose was maintained (CPG subgroup). In subgroups with PRU ≥240, clopidogrel was changed to prasugrel (PSG subgroup). We compared the occurrence of TECs with retrospective consecutive cases from January 2015 to March 2017 without PRU assessments (non-tailored group). The frequency of TECs within 30 days was assessed as the primary endpoint. RESULTS: The tailored and non-tailored groups comprised 167 and 50 patients, respectively. TECs occurred in 11 (6.6%) and 8 (16%) patients in the tailored and non-tailored groups (P=0.048), respectively. The HR for TECs was significantly reduced in the tailored group (HR 0.3, 95% CI 0.11 to 0.81); P=0.017) compared with the non-tailored group. CONCLUSION: The results suggest that tailored dual antiplatelet therapy medication with PRU significantly reduces the frequency of TECs without increasing hemorrhagic complications.
No takes yet. Share an insight, caveat, or question.
Higashiguchi et al. (2021) conducted a cohort in Unruptured cerebral aneurysms (n=217). Tailored dual antiplatelet therapy based on PRU vs. Non-tailored dual antiplatelet therapy without PRU assessments was evaluated on Frequency of thromboembolic complications (TECs) within 30 days (HR 0.3, 95% CI 0.11 to 0.81, p=0.017). Tailored dual antiplatelet therapy based on PRU significantly reduced 30-day thromboembolic complications compared to a non-tailored approach (6.6% vs 16%; HR 0.3, 95% CI 0.11-0.81).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: