Acquired platelet defect associated with gabapentin treatment: a case-report

Determination of clopidogrel effect in cats using point-of-care Plateletworks ADP and shipped samples for PFA-200 analysis in a clinical practice setting

OBJECTIVES

Clopidogrel is the recommended first-line antithrombotic in cats for a variety of conditions; however, it is ineffective in 15-20% of cats. The determination of clopidogrel effectiveness with platelet function assays has historically been limited to specialty centers; however, recent work has suggested that in-hospital or shipped analyses of samples may be feasible. The aim of the present study was to investigate the utility of an in-house analysis and shipping of blood samples collected in primary practices for the determination of clopidogrel effectiveness.

METHODS

Citrated blood samples were collected from cats receiving clopidogrel therapy by veterinarians in clinical practices across Canada, a median of 304.4 km from the reference laboratory (range 8-4425). Samples were analyzed in-house using Plateletworks ADP and shipped for remote analysis using PFA-200 P2Y and COL/ADP cartridges.

RESULTS

A total of 30 samples were collected from 25 cats. Of these, the percentage of samples analyzable for the presence or absence of the clopidogrel effect was 86% for Plateletworks ADP, 90% for PFA-200 P2Y and 87% for PFA-200 COL/ADP. There was no significant difference in the number of samples unable to be analyzed by each modality (P = 0.689) due to flow obstruction or other sample characteristics. The prevalence of absence of clopidogrel effectiveness on platelet function assays was 8% with the PFA-200 COL/ADP assay, 25% with the PFA-200 P2Y assay and 30% with the Plateletworks ADP assay.

CONCLUSIONS AND RELEVANCE

The results of this study confirm that samples of feline blood can be collected in clinical practices and shipped to a reference laboratory for PFA-200 analysis with a high rate of success, comparable to point-of-care analysis.

Middle meningeal artery embolization for postoperative supratentorial chronic subdural hematoma occurring after posterior fossa neurosurgery

Chronic subdural hematoma (CSDH) after posterior fossa surgery is rare but may occur. A 70-year-old man with trigeminal neuralgia underwent microvascular decompression. The patient took several medications for trigeminal neuralgia and tremor for a long time. The patient tended to bleed easily and did not stop well, but the bleeding was thoroughly controlled intraoperatively. A month later, he presented with left side weakness, and brain computed tomography showed huge amount of CSDH in the right cerebral convex with midline shifting. Although CSDH was completely drained via burr hole trephination, the brain was not fully expanded, and the CSDH recurred a month later. CSDH was evacuated, but there was still considerable subdural space and remained small CSDH in another superficial subdural space. We considered that the patient was at high risk of recurrence of CSDH and performed middle meningeal artery (MMA) embolization. Afterward, he did not suffer a recurrence. Here, we reviewed the risk factors of CSDH recurrence and the usefulness of MMA embolization in the treatment of CSDH, and we recommend upfront MMA embolization as an effective adjuvant to treat CSDH in patients at a high risk of recurrence of CSDH.