Low-dose prasugrel achieved effective P2Y12 resistance unit inhibition in 95.8% of clopidogrel-resistant patients undergoing treatment for cerebral aneurysms, with no hemorrhagic or thromboembolic complications.
Observational (n=24)
No
Does a 20 mg loading dose of prasugrel improve P2Y12 resistance unit (PRU) inhibition in patients with cerebral aneurysms and clopidogrel resistance undergoing stent-assisted coiling?
A 20 mg loading dose of prasugrel effectively overcomes clopidogrel resistance in patients undergoing stent-assisted coiling for cerebral aneurysms, achieving adequate platelet inhibition without early hemorrhagic complications.
Thromboembolism is one of the major complications of stent assisted coiling in treatment of cerebral aneurysm. Clopidogrel resistance is so common and prasugrel is more effective in its rapid and potent effect. We investigated changes in the value of P2Y12 resistance unit (PRU) when prasugrel was administered to patients with clopidogrel resistance. One hundred mg of aspirin and 75 mg of clopidogrel were administered for 5 days before the procedure, and PRU were examined. The resistance to clopidogrel was defined as the inhibition of PRU was less than 20%. PRU was re-examined after loading 20 mg of prasugrel. We treated 98 consecutive patients between January 2018 and July 2018, and 24 patients (24.5%) had resistance to clopidogrel. Nineteen patients were female. The mean PRU value at admission was 238.5±36.9 and the percentage inhibition value was 4.8±6.3%. After the use of prasugrel, the mean PRU and percentage inhibition values were measured as 124.9±49.9 and 48.0±19.24, respectively. All patients except one patient had a PRU inhibition value as a responder. There was no hemorrhage or thromboembolic complication during mean 1.5 months follow-up after embolization procedure. In conclusion, in patients resistant to clopidogrel, the low dose prasugrel seems to be effective in keeping the percentage inhibition value of PRU within the normal range in treatment of cerebral aneurysm. Further study will be needed to determine the optimal dose of prasugrel to enhance prevention effect of thromboembolism and to reduce hemorrhagic complications during stent assisted coiling.
Lee et al. (Mon,) conducted a observational in Cerebral Aneurysms with Clopidogrel Resistance (n=24). Prasugrel was evaluated on Responder status (PRU inhibition >20%). Low-dose prasugrel achieved effective P2Y12 resistance unit inhibition in 95.8% of clopidogrel-resistant patients undergoing treatment for cerebral aneurysms, with no hemorrhagic or thromboembolic complications.