Possibility of active management of the target P2Y12 reaction unit range in patients undergoing aneurysmal neurointerventional procedures

Abstract

Optimal antiplatelet inhibition is essential in patients undergoing neurointerventional procedures, however, variability in response to clopidogrel can contribute to thromboembolic and hemorrhagic complications. In the present study, we evaluated the impact of active management of antiplatelet reactivity in patients undergoing aneurysmal neurointerventional procedures. Between 2013 and 2016, 61 consecutive patients (male; 12, mean age; 57) underwent aneurysmal coil embolization and received clopidogrel (75 mg daily) and aspirin (100 mg daily) before the treatment under platelet function monitoring. Patients underwent prospective assessment of preoperative platelet function using VerifyNow assay and received adjunctive cilostazol (200 mg daily; triple antiplatelet therapy) in case of clopidogrel hypo-response. Patient with clopidogrel hyper-response underwent clopidogrel dose reduction according to the protocol (clopidogrel, 12.5–75 mg daily). Successful coil embolization was performed in all patients. Stent-assisted coil embolization was performed in 32 patients (53%). Preoperative clopidogrel resistance was noted in 6 patients (10%) and clopidogrel hyper response was noted in 9 patients (24%). In active management of platelet reactivity resulted in optimization of P2Y12 reaction units (PRU) value within the target range during and after the treatment. There were no symptomatic thromboembolic or hemorrhagic events. In conclusion, active management of clopidogrel dosing for clopidogrel hyper-response and adjunctive cilostazol for clopidogrel hypo-response resulted in an adjustment of PRU value to within a target range, and there were no hemorrhagic complications after the treatment.