Platelet Function Testing with a VerifyNow-Directed Personalized Antiplatelet Strategy and Associated Rates of Thromboembolic Complications After Pipeline Embolization for Complex Cerebral Aneurysms

Neyens, Ron; Donaldson, Chris; Andrews, Charles; Kellogg, Ryan T; Spiotta, Alejandro M

doi:10.1016/j.wneu.2020.03.046

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…Alongside VerifyNow, we have many choices of PFT including light transmission aggregometry ( 14 ), TEGs ( 32 ), or multiplate ( 33 ), but there is no standard method to simulate an in vivo platelet response. It remains unclear whether drug adjustments before endovascular treatment based on PFT evaluation can improve patient outcomes ( 34 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

Platelet reactivity after clopidogrel loading in patients with acute ischemic stroke

et al. 2022

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ObjectiveIt remains unclear when sufficient antiplatelet effect is achieved after administration of a loading dose of clopidogrel in patients with acute ischemic stroke (AIS). This study aimed to evaluate the clopidogrel response in patients with AIS identified by the platelet function test (PFT).MethodsP2Y12 reaction unit (PRU) values measured using VerifyNow at baseline and at 6, 24, and 72 h after administration of a loading dose (300 mg) of clopidogrel were compared between patients with AIS and those of other cerebrovascular diseases (CVD). The prevalence of clopidogrel abnormal response and its associated factors were examined.ResultsThe PRU value was significantly reduced with time in the other CVD group (p < 0.0001), and also in the AIS group (p = 0.0073). The PRU values were significantly higher in the AIS group than in the other CVD group (p < 0.0001 between the groups, baseline: 314 ± 53 vs. 284 ± 62, p = 0.35; 6 h: 290 ± 66 vs. 214 ± 71, p = 0.016; 24 h: 270 ± 75 vs. 190 ± 70, p < 0.0001; and 72 h: 231 ± 76 vs. 163 ± 93, p = 0.105). The prevalence of clopidogrel hypo-responder (PRU > 240 at 24 h after administration) was higher in the AIS group (79 vs. 33%, p < 0.0001) and associated with the baseline PRU value but not with the cytochrome P450 2C19 genotype or clinical ischemic events.ConclusionsResidual platelet reactivity at 24 h after clopidogrel loading was substantially higher in patients with AIS than in patients with other CVD. In addition, most patients with AIS were judged to be hypo-responders on PFT. This should be carefully interpreted in patients with AIS because of poor specificity for predicting clinical ischemic events.

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Section: Discussionmentioning

confidence: 99%

Platelet reactivity after clopidogrel loading in patients with acute ischemic stroke

et al. 2022

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“…3,4 Thus, studies have been conducted to determine the predictive ability of VerifyNow test results for ischemic and hemorrhagic complications in patients treated with Pipeline flow diverters. 4,5 At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is used. TEG is an inexpensive test that offers a comprehensive assessment of the hemostatic potential of whole blood, including speed of clot formation, tensile strength of the developing clot and subsequent lysis.…”

Section: Introductionmentioning

confidence: 99%

“…2 While still a controversial issue, the use of platelet function testing (PFT) in order to prevent ischemic and hemorrhagic complications has gained favor at many institutions. [3][4][5] Different types of PFTs are available, and their respective predictability has not been adequately compared or studied. The most commonly used PFT is VerifyNow (Accumetrics, San Diego, CA).…”

Section: Introductionmentioning

confidence: 99%

“…It is the preferred test at many institutions primarily due to its ease of use and that repeat measurements can be obtained rapidly to prescribe a personalized antiplatelet regimen. 3,4 Thus, studies have been conducted to determine the predictive ability of VerifyNow test results for ischemic and hemorrhagic complications in patients treated with Pipeline flow diverters. 4,5 At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is used.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

et al. 2021

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Introduction Flow diversion is an effective treatment modality for intracranial aneurysms but is associated with ischemic and hemorrhagic complications. Patients treated with flow diversion require dual antiplatelet therapy and subsequent platelet function tests. At our institution, Thromboelastography with Platelet Mapping (TEG-PM) is the test of choice. The primary objective of this study was to identify TEG parameters that are predictive of postoperative complications in patients treated with elective flow diversion. Methods This was a retrospective study of 118 patients with unruptured intracranial aneurysms treated with flow diversion. Data was collected via chart review. Bivariate analyses were performed to identify significant variables in patients who suffered an ischemic stroke or a groin hematoma. ROC curves were constructed for the TEG parameters with statistical significance. Bivariate analyses were repeated using dichotomized TEG results. Results Patients who experienced a symptomatic ischemic stroke had a history of stroke (p value = 0.007), larger aneurysm neck width (p value = 0.017), and a higher alpha angle (p value = 0.013). Cut off point for ischemic complication is 63° on ROC curve with a sensitivity of 100% and specificity of 65%. Patients who experienced a groin hematoma were no different from their healthy peers but had a lower alpha angle (p value = 0.033). Cut off point for hemorrhagic complication is 53.3° with a sensitivity of 82% and specificity of 67%. Conclusion The Alpha Angle parameter of TEG-PM has a sizeable predictive ability for both ischemic complications of the central nervous system and hemorrhagic complications of the access site after elective flow diversion.

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Cost-effectiveness of platelet function testing in dual antiplatelet therapy decision-making after intracranial aneurysm treatment with flow diversion

Wadhwa,

Ramirez-Velandia,

Mensah

et al. 2024

Neurosurg Rev

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Platelet Function Testing with a VerifyNow-Directed Personalized Antiplatelet Strategy and Associated Rates of Thromboembolic Complications After Pipeline Embolization for Complex Cerebral Aneurysms

Cited by 17 publications

References 14 publications

Platelet reactivity after clopidogrel loading in patients with acute ischemic stroke

Platelet reactivity after clopidogrel loading in patients with acute ischemic stroke

Thromboelastography (TEG) results are predictive of ischemic and hemorrhagic complications in patients with unruptured intracranial aneurysms treated with flow diversion

Cost-effectiveness of platelet function testing in dual antiplatelet therapy decision-making after intracranial aneurysm treatment with flow diversion

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