Abstract 078: Managing Clopidogrel Resistance in Neurointervention: Surveying Current Approaches

Abstract

Introduction Due to the variability in patient responses to clopidogrel, adjusting antiplatelet regimen based on platelet function testing has become a widespread practice to reduce thromboembolic complications in neurointervention. In the absence of standardized guideline, we aimed to explore the practice patterns related to clopidogrel resistance. Methods We conducted a survey targeting neurointerventionalists, comprising multiple‐choice questions and opportunities for free‐text responses when necessary. The survey was distributed via a professional society – the Society of Vascular and Interventional Neurology (SVIN) and two emailing lists – WovenEndoBridge and Neurointerventional Research Consortium. The data obtained from the responses were analyzed using descriptive statistics. Results A total of 133 neurointerventionalists representing 83 institutions within 24 countries responded to the survey. 62% of respondents tested for clopidogrel resistance prior to any neurovascular stent placements. 80% utilized VerifyNow point‐of‐care P2Y12 assay; other assays included multiplate analyzer, platelet function analyzer (PFA‐100), and CYP2C19 genotype assay. Respondents reported 25 different therapeutic thresholds, with the P2Y12 Reaction Units range between 60 and 180 most commonly used (16.4%). 61% reported they would switch to ticagrelor in the case of persistent resistance. On the other hand, when patients are supratherapeutic, 48% did not make any changes while 42% reduced clopidogrel dose. Finally, 93% felt that there was a lack of well‐established protocol for management of clopidogrel resistance. Conclusion Neurointerventional practice patterns around clopidogrel resistance remains heterogeneous. Our results underscore the need for evidence‐based guidance on anti‐thrombotic management during cerebrovascular stenting.