Abstract Number: PB0104
Meeting: ISTH 2020 Congress
Background: Flow diverters represent a major paradigm shift in the endovascular treatment of intracranial aneurysms. Periprocedural adherence to strict pharmacological protocol is important to decrease thrombosis and/or bleeding complications. In recent years controversy has arise concerning the less-than-expected effect of antiplatelet treatments, mainly P2Y12 blockers but also aspirin and its clinical implications.
Aims: To analyse the efficiency of antiplatelet treatments in patients subjected to the imposition of a flow diverter stent.
Methods: Ninety-two consecutive patients were included. All patients were taken aspirin (100 mg) and clopidogrel (75 mg) for at least a week previously to platelet reactivity studies. Platelet reactivity was assayed by light transmission aggregometry (Chronolog) (LTA) with arachidonic acid (1 mM), ADP (20 mM) and TRAP-6 (20 mM) in PRP, whole blood impedance aggregometry (Multiplate) (arachidonic acid (0.5 mM), ADP (6.4 mM) and TRAP-6 (32 mM), VerifyNow (Aspirin and P2Y12) (Werfen) in whole blood and phosphorylation of VASP by flow cytometry (Biocytex). A patient was considered to be insufficiently inhibited when at least 2 probes were below limit of optimal inhibition as previously published (1)
(1) Pharmacological inhibition of platelet reactivity. Clinical and pharmacodynamic effects. Vallés J, et al. Curr Vasc Pharmacol. 2013 Jul;11:431-47.
Results: Aspirin-related inhibition of platelet reactivity was optimal in all tested patients. In contrast, in 38 patients (42%) inhibition with clopidogrel was less than expected. Change to a higher dose of clopidogrel (150 mg/day) was enough to obtain an optimal inhibition in 26 patients (68%). The remaining patients (n=12) required treatment with ticagrelor (90 mg/twice daily) to optimally blocked P2Y12-related platelet reactivity.
Conclusions: Inadequate antiplatelet inhibition with clopidogrel appears in an important percentage (42%) of these patients and could be corrected with a higher dose of clopidogrel or switching to ticagrelor. Tailored antiplatelet treatment could be an interesting approach in these high risk patients.
To cite this abstract in AMA style:Moscardo A, Aparici F, Ferrando F, Blanquer A, Latorre AM, Bosch P, Bonanad S. Antiaggregation Evaluation of Aspirin and Clopidogrel in Endovascular Treatment of Intracranial Aneurysms with Flow Diverter Stents [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/antiaggregation-evaluation-of-aspirin-and-clopidogrel-in-endovascular-treatment-of-intracranial-aneurysms-with-flow-diverter-stents/. Accessed January 27, 2022.
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