Journal of Neuroendovascular Therapy
Online ISSN : 2186-2494
Print ISSN : 1882-4072
Original Articles
Clopidgrel Resistance and Periprocedual Thromboembolic Complications in Neuroendovascular Treatment
Satoshi ShitaraYoshinori Akiyama
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JOURNALS OPEN ACCESS

2016 Volume 10 Issue 1 Pages 19-24

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Abstract

Objective: Antiplatelet therapy is essential in neuroendovascular therapy to avoid periprocedural thromboembolic events. The purpose of our study was to evaluate the relationship between platelet aggregation analysis by VerifyNow assay system (Accumetrics, San Diego, CA, USA) and thromboembolic complications.Methods: Seventy-two neuroendovascular procedures were performed between March 2013 and February 2015 in this institution. There were 41 males (56.9%) and their mean age was 69.9 years. Meanwhile, there were 31 females (43.0%) and their mean age was 62.7 years. In all cases, clopidogrel (CLP) was used as one of the periprocedural antiplatelet therapy. All patients were measured CLP response as P2Y12 Reaction Units (PRU) value using VerifyNow assay system (Accumetrics, San Diego, CA, USA) with the whole blood sample collected from the long sheath located at the femoral artery. All patients received diffusion-weighted image (DWI) on MRI at 1–4 days after the procedure. The occurrence of thromboembolic events was recorded and the relationship between CLP response and DWI hyper-intensity area (HIA) positive was analyzed. Appropriate cut-off value to predict thromboembolic events was examined. Results: Symptomatic thromboembolic complications occured in three patients (4.1%), and each PRU value was all over 226. CLP hypo-responder in our study recognized 46 patients (63.8%) as cut-off PRU value set 208. As the result of cut-off value defined as CLP hypo-responder, with regard to PRU more than 208, a significant difference appear in DWI HIA positive or negative, but with regard to PRU more than 230, a significant difference is not recognized.Conclusion: In our study, CLP response measured by VerifyNow assay system is well correlated with the periprocedural thromboembolic events in neuroendovascular procedure. The cut-off value of PRU in neuroendovascular therapy is not still defined, but CLP hypo-responder defined PRU value more than 208 might be meaningful in neuroendovascular therapy performed to Japanese. We should make the custom-made periprocedural anti-platelet therapy according to personal response.

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