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Aggregometry Response to Half-dose Prasugrel in Flow-diverting Stent Implantation

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Abstract

Purpose

The aim of this study was to determine whether half-dose loading (30 mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10 mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation.

Methods

Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented.

Results

A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). The 6‑month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate.

Conclusion

Half-dose (30 mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm.

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Acknowledgements

The authors greatly appreciate the contributions of the following staff nurses in performing timely aggregometry tests during the endovascular procedure: Pinar Yildirim, Yunuse Ceylan, Aysel Atay, Gonul Dinc, Sultan Ozkan, Hatice Zeybekoglu.

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Correspondence to Ismail Oran.

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Conflict of interest

I. Oran, C. Cinar, M. Gok and F. Duzgun declare that they have no competing interests.

Ethical standards

All studies described in this manuscript were carried out in accordance with national law and the Helsinki Declaration from 1975 (in its current revised form). Informed consent was obtained from all individual participants included in the study and those identifiable from information within the manuscript.

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Oran, I., Cinar, C., Gok, M. et al. Aggregometry Response to Half-dose Prasugrel in Flow-diverting Stent Implantation. Clin Neuroradiol 30, 463–469 (2020). https://doi.org/10.1007/s00062-019-00804-1

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