Inadequate platelet inhibition was observed in 66% of patients on clopidogrel compared to 13% on aspirin (P<0.0001), with same-day 600 mg clopidogrel loading achieving only 16% mean inhibition.
Cohort (n=216)
Does the dose and duration of aspirin and clopidogrel affect platelet inhibition in patients undergoing neurointerventional procedures?
Premedication with clopidogrel, especially same-day loading, frequently fails to achieve adequate platelet inhibition compared to aspirin in neurointerventional procedures.
Absolute Event Rate: 66% vs 13%
p-value: p=< .0001
BACKGROUND/OBJECTIVE: Symptomatic thromboembolic events are the most common complications associated with aneurysm coiling, and carotid and intracranial stenting. Our objective is to assess the effect of aspirin (ASA) and clopidogrel dose and duration on platelet inhibition using a point of care assay in neurointerventional (NI) suite. METHOD: The dose, duration, and point of care platelet function assay data for clopidogrel and aspirin therapy were prospectively collected between February 2006 and November 2007. Inadequate platelet inhibition for ASA was defined as >or=550 ASA reaction units (ARU), and for clopidogrel was defined as or=7 days, 300 mg for 24 hours, and 600 mg same day load had a mean P2Y12/ADP inhibition of 45%, 35% (P-value = .09), and 16%, respectively (P-value = .005). CONCLUSION: Premedication with clopidogrel, in contrast to aspirin, does not achieve adequate platelet inhibition in about two-third of the patients. Same day antiplatelet loading may be insufficient to achieve adequate platelet inhibition and should be avoided if clinically feasible.
Pandya et al. (Tue,) conducted a cohort in Neurointerventional procedures (n=216). Clopidogrel vs. Aspirin was evaluated on Inadequate platelet inhibition (p=< .0001). Inadequate platelet inhibition was observed in 66% of patients on clopidogrel compared to 13% on aspirin (P<0.0001), with same-day 600 mg clopidogrel loading achieving only 16% mean inhibition.