Key result
Continuation of dual-antiplatelet therapy after neuroendovascular procedures significantly decreased median P2Y12 reaction units from 152 to 9 (p=0.001), with hemorrhagic events in 61.5% of patients.
Why the study?
This study evaluated changes in VerifyNow assay results and complications before and after neuroendovascular therapy in patients receiving continuous dual-antiplatelet therapy.
Does continuation of dual-antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) after elective neuroendovascular therapy alter platelet reactivity (VerifyNow ARU and PRU) and complication rates compared to preprocedural baseline?
Cohort (n=13)
No
Does continuation of dual-antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) after elective neuroendovascular therapy alter platelet reactivity (VerifyNow ARU and PRU) and complication rates compared to preprocedural baseline?
Answers are grounded in this paper and cite their sources.
Continuing standard-dose clopidogrel (75 mg/day) after neuroendovascular procedures can lead to a marked delayed drop in P2Y12 reaction units within the first postprocedural week, which is associated with a high rate of minor bleeding events.
Objective: Changes in the VerifyNow (Accumetrics, San Diego, CA, USA) assay results before and after neuroendovascular therapy and complications were evaluated. Methods: Of the 124 neuroendovascular procedures at our hospital between June 2014 and June 2015, 15 patients received elective treatment with dual-antiplatelet therapy (DAPT) consisting of aspirin at 100 mg/day and clopidogrel at 75 mg/day continued from at least 7 days before the procedure to the postprocedural period. Of these patients, those who underwent the VerifyNow assay before treatment and within 1 month after the procedure were included. Changes in the results of VerifyNow assay and complications were retrospectively evaluated. Results: Thirteen patients were included. The treatment was coil embolization of intracranial aneurysm in five patients (stent-assisted in four patients), carotid artery stenting in seven patients, and angioplasty and stenting for intracranial atherosclerosis in one patient. No significant change was observed in the aspirin reaction units (ARU) value after compared with before treatment. The P2Y12 reaction units (PRU) value decreased significantly after treatment (152 [interquartile range (IQR): 126–157] vs. 9 [IQR: 6–61], p = 0.001). Hemorrhagic events were observed in eight patients (61.5%) after treatment. Conclusion: Continuation of DAPT after neuroendovascular treatment may induce delayed clopidogrel hyper-response, which may lead to hemorrhagic complications.
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Endo et al. (2017) conducted a cohort in Cerebrovascular disease (intracranial aneurysm, carotid artery stenosis, or intracranial atherosclerosis) undergoing elective neuroendovascular therapy (n=13). Continuation of dual-antiplatelet therapy (aspirin 100 mg/day and clopidogrel 75 mg/day) after neuroendovascular therapy vs. Preprocedural baseline (1 day before treatment) was evaluated on P2Y12 reaction units (PRU) measured by VerifyNow assay (p=0.001). Continuation of dual-antiplatelet therapy after neuroendovascular procedures significantly decreased median P2Y12 reaction units from 152 to 9 (p=0.001), with hemorrhagic events in 61.5% of patients.
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