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May CC, Holden D, Robbins BT, Cook AM, Jung S, Smetana KS, Roels C, Harlan SS, Keegan S, Brophy G, Al Mohaish S, Sandler M, Spetz S, Wohlfarth K, Owusu-Guha J, Buschur P, Hetrick E, Dombrowski K, Glover J, Levesque M, Dingman S, Hussain M. Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents. Neurocrit Care 2024; 40:262-271. [PMID: 37322326 DOI: 10.1007/s12028-023-01749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T). METHODS This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3-6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3-6 months after the procedure. RESULTS Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p = 0.97) and no difference in any of the secondary safety outcomes. CONCLUSIONS Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.
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Affiliation(s)
- Casey C May
- Department of Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 214A Parks Hall, 500 12th Ave, Columbus, OH, 4321, USA.
| | - Devin Holden
- Department of Pharmacy, Albany Medical Center, Albany, NY, USA
| | - Blake T Robbins
- Department of Pharmacy, University of Kentucky Healthcare, Lexington, KY, USA
| | - Aaron M Cook
- Department of Pharmacy, University of Kentucky Healthcare, Lexington, KY, USA
| | - Sara Jung
- Wellstar Kennestone Hospital, Marietta, GA, USA
| | | | - Christina Roels
- Novant Health Forsyth Medical Center, Winston-Salem, NC, USA
| | | | - Shaun Keegan
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | | | | | | | | | | | | | - Pamela Buschur
- OhioHealth Riverside Methodist Hospital, Columbus, OH, USA
| | | | - Keith Dombrowski
- University of South Florida/Tampa General Hospital, Tampa, FL, USA
| | - Jennifer Glover
- University of South Florida/Tampa General Hospital, Tampa, FL, USA
| | - Melissa Levesque
- University of South Florida/Tampa General Hospital, Tampa, FL, USA
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Reduction of Preoperative Waiting Time before Urgent Surgery for Patients on P2Y 12 Inhibitors Using Multiple Electrode Aggregometry: A Retrospective Study. J Clin Med 2020; 9:jcm9020424. [PMID: 32033153 PMCID: PMC7074528 DOI: 10.3390/jcm9020424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
P2Y12 inhibitor discontinuation is essential before most surgical interventions to limit bleeding complications. Based on pharmacodynamic data, fixed discontinuation durations have been recommended. However, as platelet function recovery is highly variable among patients, a more individualized approach based on platelet function testing (PFT) has been proposed. The aim of this retrospective single-centre study was to determine whether PFT using whole blood adenosine diphosphate–multiple electrode aggregometry (ADP–MEA) was associated with a safe reduction of preoperative waiting time. Preoperative ADP–MEA was performed for 29 patients on P2Y12 inhibitors. Among those, 17 patients underwent a coronary artery bypass graft. Twenty one were operated with an ADP–MEA ≥ 19 U (quantification of the area under the aggregation curve), and the waiting time was shorter by 1.6 days (median 1.8 days, IQR 0.5–2.9), by comparison with the current recommendations (five days for clopidogrel and ticagrelor, seven days for prasugrel). Platelet function recovery was indeed highly variable among individuals. With the 19 U threshold, high residual platelet inhibition was associated with perioperative platelet transfusion. These results suggest that preoperative PFT with ADP–MEA could help reduce waiting time before urgent surgery for patients on P2Y12 inhibitors.
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