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Case report
Prevention of stent thrombosis with reduced dose of prasugrel in two patients undergoing treatment of cerebral aneurysms with pipeline embolisation devices
  1. G Morgan Jones1,
  2. Jennifer D Twilla1,
  3. Daniel A Hoit2,
  4. Adam S Arthur
  1. 1Department of Pharmacy, Methodist University Hospital, Memphis, Tennessee, USA
  2. 2Department of Neurosurgery, Semmes-Murphey Clinic/University of Tennessee, Memphis, Tennessee, USA
  1. Correspondence to Dr G Morgan Jones, gmjones09{at}gmail.com

Abstract

Prevention of intracranial stent thrombosis with dual-antiplatelet therapy is widely used in neuroendovascular procedures. However, the rising incidence of inadequate platelet inhibition with clopidogrel may increase complications following stent placement, especially with newer devices that possess a larger total metal surface area. While there are recent reports of prasugrel as an alternative to clopidogrel, there is no clinical evidence in neurointerventional patients regarding the use of a lower maintenance dose as an alternative strategy to gain adequate platelet inhibition while possibly reducing the risk of bleeding. We present 6-month efficacy and safety outcomes of two patients undergoing elective pipeline embolisation that were found to have inadequate platelet response to clopidogrel and subsequently transitioned to prasugrel 5 mg daily for the prevention of stent thrombosis.

  • Aneurysm
  • Platelets
  • Pharmacology
  • Stent

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