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Laboratory assessments of therapeutic platelet inhibition in endovascular neurosurgery: complication prediction using the VerifyNow P2Y12 assay and thromboelastography with platelet mapping
- Source :
- Journal of Neurosurgery. 134:884-892
- Publication Year :
- 2021
- Publisher :
- Journal of Neurosurgery Publishing Group (JNSPG), 2021.
-
Abstract
- OBJECTIVEInhibition of platelet aggregation is universally used to prevent thromboembolic complications related to stent placement in endovascular neurosurgery, but excessive inhibition potentiates hemorrhagic complications. Previously, the authors demonstrated that two different commercially available measures of adenosine diphosphate (ADP)–dependent platelet inhibition—the VerifyNow P2Y12 clopidogrel assay (measured in platelet reactivity units [PRU]) and maximal amplitude (MA) attributable to ADP activity (MA-ADP) derived from thromboelastography (TEG) with platelet mapping (PM)—yielded wildly different results. This study sought to analyze observed complications to quantify the ideal therapeutic windows for both tests.METHODSNinety-one patients with simultaneous or near-simultaneous PRU and TEG-PM results who underwent craniocervical endovascular stenting at the authors’ institution between September 2015 and November 2017 were identified and retrospectively enrolled. From November 2017 until June 2019, 109 additional patients were prospectively enrolled. For this study, in-hospital thrombotic and hemorrhagic complications (both CNS and non-CNS) were tabulated, and receiver operating characteristic (ROC) curve analysis was used to identify threshold values of the PRU and MA-ADP for predicting each type of complication.RESULTSOf the 200 patients enrolled, 7 were excluded because of anemia or thrombocytopenia outside of the test manufacturer’s specified ranges and 1 was excluded because they did not have a TEG-PM result. Including complications of all severities, there were a total of 15 CNS thrombotic complications, 1 access-site thrombotic complication, 3 CNS hemorrhages, 8 access-site hemorrhagic complications, and 3 hemorrhagic complications not affecting either the CNS or the access site. ROC curve analysis yielded therapeutic threshold values of 118–144 PRU. The results demonstrated PRU has a significant dose-dependent effect on the rates of thrombosis and hemorrhage. Logistic regression models did not demonstrate statistically significant relationships between the MA-ADP and either thrombosis or hemorrhage. ROC analysis based on these models is of little value and did not identify significant threshold values for MA-ADP.CONCLUSIONSThere continues to be poor correlation between the results of TEG-PM and PRU. PRU accurately predicted complications, with a relatively narrow ideal value range of 118–144. The MA-ADP alone does not appear able to accurately predict either hemorrhagic or thrombotic complications in this group.
- Subjects :
- Adult
Blood Platelets
Male
medicine.medical_specialty
Platelet Function Tests
Anemia
Neurosurgical Procedures
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
P2Y12
Thromboembolism
Internal medicine
medicine
Humans
Platelet
Prospective Studies
Aged
Dose-Response Relationship, Drug
Receiver operating characteristic
medicine.diagnostic_test
business.industry
Endovascular Procedures
Thrombosis
General Medicine
Middle Aged
Clopidogrel
medicine.disease
Receptors, Purinergic P2Y12
Thromboelastography
Thrombelastography
Carotid Arteries
030220 oncology & carcinogenesis
Purinergic P2Y Receptor Antagonists
Cardiology
Female
Stents
Complication
business
Intracranial Hemorrhages
Platelet Aggregation Inhibitors
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 19330693 and 00223085
- Volume :
- 134
- Database :
- OpenAIRE
- Journal :
- Journal of Neurosurgery
- Accession number :
- edsair.doi.dedup.....0b7874aa58e6eece0800dda76e8d836f