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Puncture site bleeding complications in patients with Clopidogrel hyper-response

Puncture site bleeding complications in patients with Clopidogrel hyper-response

Authors :
Nedeljković Žarko
Vukasinović Ivan
Majstorović Branisalva
Milosević Medenica Svetlana
Milićević Mihailo
Ilić Rosanda
Aleksić Vuk
Paunović Aleksandra
Stanimirovic Aleksandar
Scepanović Vuk
Milić Marina
Todorović Marko
Milisavljević Filip
Grujičić Danica
Source :
Romanian Neurosurgery, Vol 34, Iss 1 (2020)
Publication Year :
2020
Publisher :
London Academic Publishing, 2020.

Abstract

Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.

Details

Language :
English
ISSN :
12208841 and 23444959
Volume :
34
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Romanian Neurosurgery
Publication Type :
Academic Journal
Accession number :
edsdoj.160505c5f1c4dba8aa41ce8d18e0d6d
Document Type :
article