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  • Active management of the target P2Y12 reaction unit range in patients undergoing stent-assisted coil embolization for unruptured cerebral aneurysms

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Hemorrhagic stroke
Original research
Active management of the target P2Y12 reaction unit range in patients undergoing stent-assisted coil embolization for unruptured cerebral aneurysms
  1. Ichiro Nakagawa1,
  2. Hun Soo Park1,
  3. Masashi Kotsugi1,
  4. Shohei Yokoyama1,
  5. Kenta Nakase1,
  6. Takanori Furuta1,
  7. Kaoru Myouchin2,
  8. Shuichi Yamada1,
  9. Hiroyuki Nakase1
  1. 1 Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
  2. 2 Department of Radiology, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
  1. Correspondence to Dr Ichiro Nakagawa, Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara 6348522, Japan; nakagawa{at}naramed-u.ac.jp

Abstract

Background Platelet function tests have been increasingly adopted to measure patient responses to antiplatelet drugs, and to predict complications. However, no established optimal antiplatelet management for stent-assisted coil embolization (SAC) have been established. The purpose of the present study was to investigate the efficacy and feasibility of clopidogrel dose adjustment for active target P2Y12 reaction unit (PRU).

Methods A total of 202 consecutive patients undergoing SAC to treat unruptured intracranial aneurysms were prospectively recruited. All patients were given two antiplatelet agents starting 7 days prior to the procedure, and platelet function was measured with the VerifyNow test. Clopidogrel hyper-responsive patients received reduced dosing according to the values of follow-up PRUs before and 7, 14, 30, and 90 days after the procedure. Patients were divided into three groups according to clopidogrel responsiveness before treatment, and clinical outcomes and time in target PRU ranges (TTR) were analyzed.

Results No delayed ischemic or hemorrhagic events occurred that were associated with out-of-range PRU. PRU values in the hypo-responsive and hyper-responsive groups significantly improved 7 days after treatment with active target PRU management (p=0.05,<0.001, respectively). PRU values were controlled within the target PRU range with drug adjustment (p=0.034), and the time in TTR for all patients was 97% (4.8%–100%), which showed the feasibility of optimal control of PRU values with the protocol.

Conclusion Active target PRU management can achieve control of optimal PRU values and may decrease perioperative ischemic and hemorrhagic events among patients undergoing SAC.

  • aneurysm
  • complication
  • platelets
  • stent

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2020-017249

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors IN, HSP, MK and SY conceived of the study, drafted the manuscript, and edited the manuscript. KN, TF, KM, SY, and HN provided critical editing and guidance for the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.