Abstract Number: PB0427
Meeting: ISTH 2021 Congress
Theme: Fibrinogen, Fibrinolysis and Proteolysis » Thrombolytic Therapy
Background: The implantation of stents in cerebral arteries must be preceded by the administration of antiplatelets agents based on a dual therapy with Aspirin (Kardegic®) and a P2Y12 inhibitor. Devices can monitor the action of the P2Y12 inhibitor, such as the Multiplate® which can predict the phenomenon called “high on-treatment platelet reactivity ».
Aims: This study focuses on the use of platelet function monitoring in the context of a prescription of clopidogrel and its possible replacement by ticagrelor.
Methods: We performed an observational retrospective cohort monocentric study from January 2017 to June 2020.
Patients received a prescription for 5 days of clopidogrel (75mg per day) before the procedure. The day before the procedure, if adenosine diphosphate (ADP) test result was above 300 area under the curve on multiplate, patients were considered as resistant to clopidogrel and Ticagrelor was introduced (dosage = 180mg).
We collected ADP test results from Multiplate® at the anaesthesiologist consultation and the day before the surgery
The primary endpoint was the occurrence of thromboembolic or haemorrhagic events for one month postoperatively.
Results: 104 patients were included, and all benefitted from the treatment of an intracerebral aneurysm. 76 patients were classified as respondent to clopidogrel regarding local protocol and received clopidogrel. 28 had to be switched from clopidogrel to ticagrelor according to local protocol. Eight patients under clopidogrel (10.5%) had an ischemic event and 3 under ticagrelor (11%) during the 30 days post-operative period. No patient had a haemorrhagic event under clopidogrel and 2 under ticagrelor (7.5%) during the same period. The difference was not statistically significant regarding ischemic or haemorrhagic event and treatment (p-value = 0.055). 
Flow Chart
ADP test evolution (on Day 0 and on Day 5) regarding drug administration and events
Conclusions: The use of a platelet function monitoring device helps reduce the risk of treatment complications (ischemic or haemorrhagic). The definition of a threshold below 300 AUC could likely result in improved morbidity at 30 days.
To cite this abstract in AMA style:
Duranteau O, Drir M, Abdenour L, Degos V. P2Y12 Inhibitors Administration in Intracranial Stent Procedure, the Usefulness of Monitoring [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/p2y12-inhibitors-administration-in-intracranial-stent-procedure-the-usefulness-of-monitoring/. Accessed September 22, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/p2y12-inhibitors-administration-in-intracranial-stent-procedure-the-usefulness-of-monitoring/