Abstract
BackgroundDual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications.MethodsPatients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter).ResultsFrom 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups.ConclusionLong term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.
Highlights
Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling
According to American College of Cardiology Foundation (ACCF)/ American Heart Association (AHA) 2011 guidelines [8], we defined the cut off value of P2Y12 Reaction Units (PRU) at 208, and classified patients as hypo-responders (PRU≧208) or responders (PRU
Some studies have shown an association of hyper-responders to clopidogrel hemorrhagic events while hypo-responders are associated with thrombotic events, a clear cutoff value has not been defined for neuroendovascular treatments and this value differed among studies [16,17,18,19,20,21,22]
Summary
Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. Long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. In the treatment of intracranial aneurysms, adjunctive techniques such as the balloon assist technique or stent assisted coiling are effective for wide-necked aneurysms and decrease recurrence rates. Periprocedural dual antiplatelet therapy (DAPT) is necessary to reduce increasing thrombotic complications as the procedure complexity augments [1,2,3]. This study aimed to clarify the relationship between clopidogrel responses and complications. (Accumetrics, San Diego, CA, USA) and investigated its association to clopidogrel responses and the occurrence of hemorrhagic and thrombotic events within 30 days of stent assisted coiling and 30 days after stent assisted coiling
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