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Original research
Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy
  1. Hidehisa Nishi1,
  2. Ichiro Nakahara2,
  3. Shoji Matsumoto1,3,
  4. Tetsuya Hashimoto4,
  5. Tsuyoshi Ohta5,
  6. Nobutake Sadamasa1,
  7. Ryota Ishibashi1,
  8. Masanori Gomi1,
  9. Makoto Saka1,
  10. Haruka Miyata1,
  11. Sadayoshi Watanabe2,
  12. Takuya Okata1,
  13. Kazutaka Sonoda1,
  14. Junpei Kouge1,
  15. Akira Ishii1,
  16. Izumi Nagata1,
  17. Jun-ichi Kira3
  1. 1Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan
  2. 2Department of Neurosurgery, Fujita Health University, Aichi, Japan
  3. 3Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  4. 4Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  5. 5Department of Neurosurgery, Kochi Health Science Center, Kochi, Japan
  1. Correspondence to Dr Hidehisa Nishi, Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu-shi, Fukuoka 802-8555, Japan; venturahighway83{at}


Background and purpose Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy.

Methods From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications.

Results A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications.

Conclusions The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170–180 is predictive of hemorrhagic complications.

  • Intervention
  • Drug
  • Pharmacology
  • Hemorrhage

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