2024 Volume 52 Issue 6 Pages 453-458
Objective: Perioperative antiplatelet therapy is crucial for preventing complications during the treatment of cerebral aneurysms with a flow diverter (FD). We retrospectively compared the perioperative use of clopidogrel and prasugrel.
Methods: We evaluated 43 consecutive patients who had undergone FD treatment at our institution between April 2020 and August 2023 (clopidogrel group, n = 20; prasugrel group, n = 23). Dual antiplatelet therapy, consisting of acetylsalicylate and a thienopyridine, was initiated two weeks prior to FD treatment. The P2Y12 reaction unit (PRU) was measured using the VerifyNow system the day before and one week after surgery. The therapeutic window was defined as 60 < PRU < 200. If the PRU value fell outside the therapeutic window, the thienopyridine antiplatelet drug was changed, its dose was adjusted, or cilostazol was added before FD treatment. VerifyNow measurements were repeated until the PRU was within the therapeutic window following treatment or if symptoms potentially related to the antiplatelet drugs occurred.
Results: The number of patients within the PRU therapeutic window preoperatively, postoperatively, and at the final assessment were 12/20, 9/20, and 18/20 in the clopidogrel group and 22/23, 21/23, and 22/23 in the prasugrel group, respectively (p = 0.007, 0.002, and 0.590, respectively). The median number of VerifyNow measurements was 3.0 (interquartile range [IQR]: 2.00–3.75) in the clopidogrel group and 2.0 (IQR: 2.00–2.00) in the prasugrel group (p < 0.001). The number of patients who required dose adjustments or a change in the thienopyridine antiplatelet drug was 16/20 in the clopidogrel group and 2/23 in the prasugrel group (p < 0.001).
Conclusion: Prasugrel effectively stabilized the PRU within the therapeutic window during the perioperative period of FD treatment. We suggest that prasugrel may be more suitable than clopidogrel for use in FD treatment.
