Abstract Number: PB1398
Meeting: ISTH 2020 Congress
Theme: Platelet Disorders and von Willebrand Disease » Antiplatelet Therapy
Background: Dual antiplatelet therapy (DAPT) with acethyl-salicic acid (ASA) and clopidogrel has been recommended in patients with cerebral aneurysms who are going to be submitted to endovascular procedures, to prevent thromboembolic events.
Resistance to APT is not rare. It may be assessed using point-of-care assays, allowing a change of dose or type of antiplatelet agents in order to achieve the desired levels.
Aims: To evaluate DAPT response in patients with cerebral aneurysms before intracranial stenting.
Methods: We retrospectively analyzed, from January 2015 to June 2019, DAPT response in 22 patients (18 females, median age 50.8 years-old) with cerebral aneurysms before intracranial stenting. Thrombotic or bleeding complications associated to the procedures were also evaluated.
To evaluate DAPT response, PFA-200 System (Col/EPI and Col/P2Y12 cartridges) was used in all patients, impedance aggregometry (ASPI and ADP tests) was used in 10 patients. Results were compared to decide which test should be used.
Results: AAS resistance was found in 3 (13.6%) patients and clopidogrel resistance in 11 (50%) patients. PFA and impedance aggregometry gave similar results when used concomitantly. Three hemorrhagic complications were observed within 24 h after intervention in patients without resistance to DAPT: 1 massive intracranial hemorrhage leading to death, 2 extracranial bleedings efficiently controlled. One patient resistant to clopidogrel had an ischemic stroke leading to mild neurological impairment.
In clopidogrel resistant group, 6 patients received higher doses of clopidogrel and clopidogrel was replaced with ticagrelor in 5 patients.
Conclusions: DAPT is used to prevent thromboembolic complications. In our small study, a high prevalence of clopidogrel resistance was found. Ticagrelor is a reversible P2Y12 inhibitor with predictable activity and rare low responders. Replacing clopidogrel with ticagrelor in all patients without DAPT response evaluation could be the strategy to follow.
To cite this abstract in AMA style:
Goncalves L, Goncalves D, Monteiro C, Koch C. Evaluation of Dual Antiplatelet Therapy Combining Aspirin and Clopidogrel for Intracranial Stenting Procedures: A Retrospective Single Center Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/evaluation-of-dual-antiplatelet-therapy-combining-aspirin-and-clopidogrel-for-intracranial-stenting-procedures-a-retrospective-single-center-study/. Accessed October 2, 2023.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/evaluation-of-dual-antiplatelet-therapy-combining-aspirin-and-clopidogrel-for-intracranial-stenting-procedures-a-retrospective-single-center-study/