Article Text

PDF
Original research
Safety and efficacy of ticagrelor for neuroendovascular procedures. A single center initial experience
  1. Ricardo A Hanel1,
  2. Philipp Taussky1,
  3. Tanya Dixon2,
  4. David A Miller3,
  5. Merlie Sapin1,
  6. Jerah D Nordeen4,
  7. Rabih G Tawk1,
  8. Ramon Navarro2,
  9. Gretchen Johns5,
  10. William D Freeman6,7
  1. 1Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
  2. 2Division of Endovascular Surgery, Mayo Clinic, Jacksonville, Florida, USA
  3. 3Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
  4. 4Department of Pharmacy, Mayo Clinic, Jacksonville, Florida, USA
  5. 5Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
  6. 6Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
  7. 7Division of Critical Care, Mayo Clinic, Jacksonville, Florida, USA
  1. Correspondence to Dr R A Hanel, Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville FL-32224, USA; hanel.ricardo{at}mayo.edu

Abstract

Introduction Although platelet response testing is controversial, up to one-third of neuroendovascular patients are ‘resistant’ to clopidogrel and are at risk for in stent thrombotic complications and may require alternative antiplatelet therapy. Ticagrelor is a new reversible ADP P2Y12 platelet receptor inhibitor with no known resistance. We describe the clinical experience with ticagrelor for neuroendovascular procedures as an alternative in clopidogrel P2Y12 platelet resistant patients.

Methods We reviewed our cerebrovascular database for all patients who were non-responders to clopidogrel, defined as P2Y12% inhibition <30%, despite repeat clopidogrel loading dose of at least 600 mg, and who were then administered ticagrelor.

Results 18 patients were non-responders to clopidogrel; 10 (56%) were men, eight (44%) were women, with a median age of 61 years (range 38–84). All patients received loading doses of at least 600 mg of clopidogrel and showed P2Y12 levels below 20% prior to ticagrelor administration. Patients were loaded with 180 mg of ticagrelor, and all but one patient showed an initial P2Y12 response above 60%. 11 patients underwent stenting, two underwent coiling, and five underwent treatment by pipeline embolization device. No patient experienced any adverse effects in the postoperative period related to the use of ticagrelor.

Conclusions Ticagrelor offers an effective alternative to clopidogrel non-responders. All of our patients showed immediate platelet inhibition after a loading dose of 180 mg of ticagrelor, with no adverse effects. The cost of medication, patient compliance (twice a day doses), and reversible inhibition should be taken into consideration when using ticagrelor.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.