Authors | Total no of cases | Total no of patients | PRU Hypo >240 | PRU Hyper <60 | % HC (PRU hyper) | % TC (PRU hypo) | Pretreatment | M | F | Age | Median age | Age SD or range | F | Age | Median age | Age SD or range |
Delgado et al 12 | NR | 100 | 15 | 45 | 11 | 60 | Clopidogrel therapy started 7–10 days before procedure with standard 75 mg daily clopidogrel dose. During the initial part of the study period, clopidogrel hyporesponders were switched to prasugrel, while for the latter part of the study period the clopidogrel dose was increased to 150 mg daily for clopidogrel hyporesponders | 24 | 76 | 57.3 | 59 | 25–82 | 76 | 57.3 | 59 | 25–82 |
Delgado et al 13 | 48 | 44 | 3 | 13 | 15.4 | 66.7 | For the majority of elective PED procedures (83%), DAT was started 10 days before the procedure with 325 mg aspirin daily and 75 mg clopidogrel daily. Clopidogrel hyporesponders switched to prasugrel. Prasugrel hyporesponders switched to ticagrelor | 36 | 8 | 59.2 | 63 | 31–81 | 8 | 59.2 | 63 | 31–81 |
Delgado et al 11 | 48 | 44 | 2 | 9 | 44 | 100 | DAT was started 10 days before the procedure with 325 mg aspirin daily and 75 mg clopidogrel daily. The clopidogrel response was assessed the day before the procedure. Clopidogrel hyporesponders switched to prasugrel. Prasugrel hyporesponders switched to ticagrelor | 36 | 8 | 59.2 | 63 | 31–81 | 8 | 59.2 | 63 | 31–81 |
Daou JNS 2016 14 | NR | 248 | 18 for PRU >240 (PRU >200 = 42) | 51 | 15.7 | 16.7 (>200 = 6/42) | Patients were started on 75 mg/day clopidogrel and 81 mg/day aspirin for at least 10 days before the intervention. If patients were resistant to clopidogrel with supratherapeutic PRU values, they were loaded with either prasugrel or ticagrelor | 45 | 203 | 57 | NR | NR | 203 | 57 | NR | NR |
Bender et al 15 | NR | 52 | (PRU >200 = 52) | NA | NA | 4 | All patients received DAT with aspirin and either clopidogrel (49 patients, 94%) or prasugrel (3 patients, 6%). In selected cases where patients were found to have very low PRU values and clinical signs of hyper-response, medication changes or dosage adjustments were made and procedures delayed as necessary; no action was taken for patients with elevated PRU values | 13 | 39 | 57 | NR | 25–85, +−16 | 39 | 57 | NR | 25–85, +−16 |
Tan et al 8 | NR | 74 | (PRU >208 = 39) | (PRU <208 = 35)* | 2.9 | 12.8 | DAT (clopidogrel 75 mg daily and aspirin 325 mg daily) was started 5 days prior to the planned procedure. Alternatively, some patients were loaded with clopidogrel 600 mg and aspirin 325 mg at least 2 hours before surgery. If a patient was a hyporesponder to both clopidogrel and aspirin (ie, ARU >550 and PRU >230), an intra-arterial loading dose of abciximab (0.25 mg/kg) was initiated at the time of PED placement, followed by a 12-hour infusion (0.125 µg/kg/min or 10 µg/min) | 12 | 62 | 60 | NR | 28–85 | 62 | 60 | NR | 28–85 |
Adeeb et al 17 | 414 | 402 | (PRU >208 = 112) | (PRU <208 = 290)* | 3.4 (overall HC rate for non-responders and responders, no statistically significant difference between the two groups) | 17.4 | Patients received aspirin 325 mg daily and clopidogrel 75 mg daily for 3–14 days before the intervention. For non-responders, the choice to continue on same dose clopidogrel, administer a one-time 600 mg clopidogrel boost within 24 hours pre-procedure, or switch to ticagrelor was at the discretion of the interventionalist performing the procedure | 71 | 331 | NR | 58 | NR | 4.7 | NR | 58 | NR |
Raychev et al 16 | 48 | 45 | (%inhibition <50%) Assumption here, >patients split in half so 24 | (%inhibition >75%) | NR for specific group (17% overall) | NR for specific group (12.5) | All patients received DAT with aspirin 325 mg daily and clopidogrel 75 mg daily for at least 3 consecutive days prior to the day of the planned procedure | 11 | 35 | NR | 58 | NR | 35 | NR | 58 | NR |
Griessenauer et al 18 | 63 | 63 | (PRU >210) 35% of patients, >22 | (PRU <60) 65% of patients, >41 | 0 | 9 | Patients were given aspirin 325 mg and clopidogrel 75 mg; dose was adjusted if PRU was outside the 60–210 range. In most cases, If the PRU remained >210 even with a maximum dose of 150 mg, patients were switched to an alternative antiplatelet agent such as prasugrel or ticagrelor | 11 | 52 | 58.36 | NR | [+−14.01] | 52 | 58.36 | NR | [+−14.01] |
Griessenauer et al 18 | 165 | 165 | 40%, >66 patients | 99 patients | 4.5 | 13.6 | Patients were loaded with aspirin 650 mg and ticagrelor 180 mg | 28 | 137 | 57.86 | NR | [+−11.98] | 137 | 57.86 | NR | [+−11.98] |
Daou JNS 2016 B | NR | 248 | (PRU >200 = 42) | (PRU <70 = 63) | 15.9 | (PRU >200 = 6/42) 14.3 | Patients were started on 75 mg/day clopidogrel and 81 mg/day aspirin for at least 10 days before the intervention. If patients were resistant to clopidogrel with supratherapeutic PRU values, they were loaded with either prasugrel or ticagrelor | 45 | 203 | 57 | NR | NR | 203 | 57 | NR | NR |
Daou JNS 2016 B | NR | 248 | (PRU >200 = 42) | (PRU <70 = 63) | 15.9 | (PRU >200 = 6/42) 14.3 | Patients were started on 75 mg/day clopidogrel and 81 mg/day aspirin for at least 10 days before the intervention. If patients were resistant to clopidogrel with supratherapeutic PRU values, they were loaded with either prasugrel or ticagrelor | 45 | 203 | 57 | NR | NR | 203 | 57 | NR | NR |
*Not included in statistical analysis due to inadequate classification as non-response as opposed to hypo-response.
DAT, dual antiplatelet therapy; HC, hemorrhagic complications; PED, Pipeline Embolization Device; PRU, platelet reactivity unit; TC, thrombotic complications.