Abstract

Clopidogrel and Prasugrel are both platelet inhibitors that act on the P2Y12 adenosine diphosphate receptor. Clopidogrel utilizes a multi-step inhibition process while Prasugrel inhibits platelet functioning in a single step. In part due to these differences in mechanisms of action, an estimated 30% of patients treated with Clopidogrel are non-responders as compared to Prasugrel that has a very low rate of non-respondance. Inadequate platelet inhibition is associated with delay of care, often requiring operative rescheduling, and increased incidence of ischemic events. In our study, we compare a cohort of patients undergoing cerebral aneurysm embolization with flow diversion in matched controls who were treated with Clopidogrel. We compare P2Y12 reaction unit (PRU) levels at sets of time point pre, peri and post-operatively, to measure response to Prasugrel versus Clopidogrel. We also evaluate if sub-optimal responses to Prasugrel or Clopidogrel resulted in delay of patient care. Early findings suggest that treatment with Prasugrel results in faster time to therapeutic PRU levels and more consistent PRU levels as compared to Clopidogrel resulting in less delay of care and operative rescheduling.