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Platelet-Function Testing in Patients Undergoing Neurovascular Procedures: Caught between a Rock and a Hard Place
- Source :
- AJNR Am J Neuroradiol
- Publication Year :
- 2012
- Publisher :
- American Society of Neuroradiology (ASNR), 2012.
-
Abstract
- Antiplatelet drug resistance has been associated with thromboembolic complications in patients after coronary stent placement. It has not been well-studied in patients who have neurovascular stent-placement procedures. This study aimed to analyze the relationship between antiplatelet drug resistance and neurovascular stent-placement complications.A prospective data base of all patients treated at our institution was used to identify patients with neurovascular stent-placement procedures. During a 4.5-year period, all patients undergoing neurovascular stent placement were evaluated for aspirin and clopidogrel resistance by using the VerifyNow assay. During an observational phase, all patients received 75 mg of clopidogrel and aspirin (group A). During the intervention phase (group B), patients were given additional clopidogrel on the basis of the clopidogrel resistance assay. We assessed the development of thromboembolic complications within 30 days of the procedure in patients who were resistant-versus-nonresistant to clopidogrel.Of 96 patients who had neurovascular stent placement, 5.2% were resistant to aspirin and 36.5% were resistant to clopidogrel. Periprocedural thromboembolic complications were seen in 7 patients (7.3%). In a multivariate logistic regression model, clopidogrel resistance, higher diastolic blood pressure, and lack of statin use were significantly associated with periprocedural thromboembolic complication. There was a nonsignificant decrease in thromboembolic complications in patients whose clopidogrel dosage was tailored to the assay.In our series, clopidogrel resistance was associated with increased periprocedural thromboembolic complications from neurovascular stent-placement procedures. Targeting the clopidogrel dose to platelet inhibition assays may improve clinical outcomes and requires further study.
- Subjects :
- Blood Platelets
Male
medicine.medical_specialty
Ticlopidine
Platelet Aggregation
Drug Resistance
Clopidogrel resistance
Context (language use)
Thromboembolism
medicine
Humans
Radiology, Nuclear Medicine and imaging
In patient
Platelet
cardiovascular diseases
Intensive care medicine
Aged
Retrospective Studies
Aspirin
Dose-Response Relationship, Drug
business.industry
Endovascular Procedures
Cerebral Arteries
Middle Aged
Neurovascular bundle
Clopidogrel
Surgery
Platelet aggregation inhibitor
Female
Stents
Patient Safety
Neurology (clinical)
business
Platelet Aggregation Inhibitors
circulatory and respiratory physiology
medicine.drug
Subjects
Details
- ISSN :
- 1936959X and 01956108
- Volume :
- 34
- Database :
- OpenAIRE
- Journal :
- American Journal of Neuroradiology
- Accession number :
- edsair.doi.dedup.....8c4291add5b418c349c2df8408657800