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Safety and efficacy of antiplatelet response assay and drug adjustment in coil embolization: a propensity score analysis

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The purpose of this study was to explore the safety and efficacy of an antiplatelet response assay and drug adjustment to prevent delayed thromboembolic events after stent-assisted coil embolization.

Methods

A total of 370 patients were enrolled in this study between December 2005 and July 2014. Of these, 124 patients were placed into the drug resistance test (DRT) group with drug adjustment according to response to an antiplatelet agent, and 246 patients comprised the control group with a standard antiplatelet regimen. The response to the antiplatelet agent was evaluated with the VerifyNow Rapid Platelet Function Assay. Propensity score matching analysis was performed with one-to-multiple matching.

Results

Among 370 patients, delayed thromboembolic events occurred in 28 (7.6 %) patients including 25 (10.2 %) in the control group and three (2.4 %) in the DRT group. Antiplatelet response test (p = 0.012), diabetes mellitus (DM) (p = 0.014), and hypertension (HTN) (p < 0.001) were associated with delayed infarction in multivariate analysis. In propensity score matching analysis, 331 patients were matched (control group (n = 229) vs. DRT group (n = 103)), and antiplatelet response (hazard ratio 0.247, 95 % confidence interval 0.070–0.868, p = 0.029) was correlated with delayed infarction. Conversely, the two groups were not significantly different with regard to total (p = 0.368) or major hemorrhagic complications (p = 0.108).

Conclusion

Antiplatelet drug adjustment according to the results of an antiplatelet response assay might be associated with a decreased risk of delayed thromboembolic infarction compared with the standard antiplatelet regimen.

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References

  1. Akpek S, Arat A, Morsi H, Klucznick RP, Strother CM, Mawad ME (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231

    PubMed  Google Scholar 

  2. Galal A, Bahrassa F, Dalfino JC, Boulos AS (2013) Stent-assisted treatment of unruptured and ruptured intracranial aneurysms: clinical and angiographic outcome. Br J Neurosurg 27:607–616

    Article  PubMed  Google Scholar 

  3. Wanke I, Forsting M (2008) Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50:991–998

    Article  PubMed  Google Scholar 

  4. Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafe A, Costalat V, French SI (2013) Safety and efficacy of neuroform for treatment of intracranial aneurysms: a prospective, consecutive, French multicentric study. AJNR Am J Neuroradiol 34:1203–1208

    Article  CAS  PubMed  Google Scholar 

  5. Ryu CW, Park S, Shin HS, Koh JS (2015) Complications in stent-assisted endovascular therapy of ruptured intracranial aneurysms and relevance to antiplatelet administration: a systematic review. AJNR Am J Neuroradiol 36:1682–1688

    Article  PubMed  Google Scholar 

  6. Oxley TJ, Dowling RJ, Mitchell PJ, Davis S, Yan B (2011) Antiplatelet resistance and thromboembolic complications in neurointerventional procedures. Front Neurol 2:83

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mocco J, Fargen KM, Albuquerque FC, Bendok BR, Boulos AS, Carpenter JS, Fiorella DJ, Hoh BL, Howington JU, Liebman KM, Natarajan SK, Rai AT, Rodriguez-Mercado R, Siddiqui AH, Snyder KV, Veznedaroglu E, Hopkins LN, Levy EI (2011) Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. Neurosurgery 69:908–913

    Article  CAS  PubMed  Google Scholar 

  8. Hwang G, Kim JG, Song KS, Lee YJ, Villavicencio JB, Suroto NS, Park NM, Park SJ, Jeong EA, Kwon OK (2014) Delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysm: characteristics and optimal duration of preventative dual antiplatelet therapy. Radiology 273:194–201

    Article  PubMed  Google Scholar 

  9. Delgado Almandoz JE, Crandall BM, Scholz JM, Fease JL, Anderson RE, Kadkhodayan Y, Tubman DE (2013) Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the pipeline embolization device. J Neurointerv Surg 5(Suppl 3):iii3–ii10

    Article  PubMed  Google Scholar 

  10. Maruyama H, Takeda H, Dembo T, Nagoya H, Kato Y, Fukuoka T, Deguchi I, Horiuchi Y, Tanahashi N (2011) Clopidogrel resistance and the effect of combination cilostazol in patients with ischemic stroke or carotid artery stenting using the VerifyNow P2Y12 assay. Intern Med 50:695–698

    Article  CAS  PubMed  Google Scholar 

  11. Ernst M, Yoo AJ, Kriston L, Schonfeld MH, Vettorazzi E, Fiehler J (2015) Is visual evaluation of aneurysm coiling a reliable study end point? Systematic review and meta-analysis. Stroke 46:1574–1581

    Article  PubMed  Google Scholar 

  12. Ferre JC, Carsin-Nicol B, Morandi X, Carsin M, de Kersaint-Gilly A, Gauvrit JY, Desal HA (2009) Time-of-flight MR angiography at 3 T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils. Eur J Radiol 72:365–369

    Article  PubMed  Google Scholar 

  13. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123:2736–2747

    Article  PubMed  Google Scholar 

  14. Banks JL, Marotta CA (2007) Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 38:1091–1096

    Article  PubMed  Google Scholar 

  15. Aradi D, Storey RF, Komocsi A, Trenk D, Gulba D, Kiss RG, Husted S, Bonello L, Sibbing D, Collet JP, Huber K, Working Group on Thrombosis of the European Society of C (2014) Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention. Eur Heart J 35:209–215

    Article  PubMed  Google Scholar 

  16. Hwang G, Huh W, Lee JS, Villavicencio JB, Villamor RB Jr, Ahn SY, Kim J, Chang JY, Park SJ, Park NM, Jeong EA, Kwon OK (2015) Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high on-treatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: a randomized clinical trial. JAMA Neurol 72:764–772

    Article  PubMed  Google Scholar 

  17. Levy EI, Boulos AS, Bendok BR, Kim SH, Qureshi AI, Guterman LR, Hopkins LN (2002) Brainstem infarction after delayed thrombosis of a stented vertebral artery fusiform aneurysm: case report. Neurosurgery 51:1280–1284 discussion 1284-1285

    Article  PubMed  Google Scholar 

  18. Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MS, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA, American Heart Association Stroke C, Council on C, Stroke N, Council on Clinical C, Council on Functional G, Translational B, Council on H (2014) Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45:3754–3832

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rossen JD, Chalouhi N, Wassef SN, Thomas J, Abel TJ, Jabbour PM, Kung DK, Hasan DM (2012) Incidence of cerebral ischemic events after discontinuation of clopidogrel in patients with intracranial aneurysms treated with stent-assisted techniques. J Neurosurg 117:929–933

    Article  CAS  PubMed  Google Scholar 

  20. Goh C, Churilov L, Mitchell P, Dowling R, Yan B (2013) Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. AJNR Am J Neuroradiol 34:721–726

    Article  CAS  PubMed  Google Scholar 

  21. Brinjikji W, Lanzino G, Cloft HJ, Siddiqui AH, Hanel RA, Kallmes DF (2015) Platelet testing is associated with worse clinical outcomes for patients treated with the pipeline embolization device. AJNR Am J Neuroradiol 36:2090–2095

    Article  CAS  PubMed  Google Scholar 

  22. Wiviott SD, Braunwald E, McCabe CH, Horvath I, Keltai M, Herrman JP, Van de Werf F, Downey WE, Scirica BM, Murphy SA, Antman EM, Investigators T-T (2008) Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes treated with percutaneous coronary intervention and stenting in the TRITON-TIMI 38 trial: a subanalysis of a randomised trial. Lancet 371:1353–1363

    Article  CAS  PubMed  Google Scholar 

  23. Hashiguchi M, Ohno K, Nakazawa R, Kishino S, Mochizuki M, Shiga T (2004) Comparison of cilostazol and ticlopidine for one-month effectiveness and safety after elective coronary stenting. Cardiovasc Drugs Ther 18:211–217

    Article  CAS  PubMed  Google Scholar 

  24. Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, Antman EM (2009) Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 373:723–731

    Article  CAS  PubMed  Google Scholar 

  25. Saraf S, Bensalha I, Gorog DA (2009) Antiplatelet resistance-does it exist and how to measure it? Clin Med Cardiol 3:77–91

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Hasan MS, Basri HB, Hin LP, Stanslas J (2013) Genetic polymorphisms and drug interactions leading to clopidogrel resistance: why the Asian population requires special attention. Int J Neurosci 123:143–154

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea

    Min Soo Kim

  2. Department of Neurosurgery, Hana General Hospital, Cheongju, South Korea

    Kyung Il Jo

  3. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea

    Je Young Yeon, Jong Soo Kim & Seung Chyul Hong

  4. Department of Radiology, Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Keon Ha Kim & Pyoung Jeon

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  1. Min Soo Kim
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  2. Kyung Il Jo
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Correspondence to Seung Chyul Hong.

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We declare that this manuscript does not contain clinical studies or patient data. The Samsung Medical Center Institutional Review Board waived consent for this retrospective study.

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We declare that we have no conflict of interest.

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Kim, M.S., Jo, K.I., Yeon, J.Y. et al. Safety and efficacy of antiplatelet response assay and drug adjustment in coil embolization: a propensity score analysis. Neuroradiology 58, 1125–1134 (2016). https://doi.org/10.1007/s00234-016-1742-6

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  • DOI: https://doi.org/10.1007/s00234-016-1742-6

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