The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysis

Kim, Hyun Jung; Oh, Jae Sang; Park, Sukh Que; Yoon, Seok-Mann; Ahn, Hyeong Sik; Kim, Bum Tae

doi:10.3340/jkns.2019.0082

Cited by 8 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are some methods to measure platelet functions, VerifyNow being one of the major point of care platelet reactivity analysis tools and employed on large clinical trials [14,15]. Some studies have shown an association of hyper-responders to clopidogrel hemorrhagic events while hypo-responders are associated with thrombotic events, although a clear cutoff value has not been de ned for neuroendovascular treatments and this value differed among studies [16][17][18][19][20][21]. Based on the ACCF/AHA 2011 guideline [8], we de ned 208 as cutoff value and investigated hemorrhagic and thrombotic events both in the acute and delayed phase.…”

Section: Discussionmentioning

confidence: 99%

“…Although some studies of stent assisted coiling reported an association of hemorrhagic and thrombotic events with PRU values in the acute phase [17][18][19][20][21], there are few studies of association between platelet reactivity and these events in the delayed phase after stent assisted coiling. Goh et al reported that evaluating hemorrhagic events up to 6 weeks after endovascular stenting treatment indicated that patients with > 72% PRU inhibition had more major bleeding than those with PRU < 72% [22].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

WITHDRAWN: Long-term Complications After Stent Assist Coiling Dependent on Clopidogrel Response

Shoda

Enomoto

Egashira

et al. 2021

Preprint

View full text Add to dashboard Cite

BACKGROUND: Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications.METHODS: Patients who underwent stent assisted coiling for unruptured aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208, and classified patients as hypo-responders (PRU≧208) or responders (PRU＜208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter).RESULTS: From 62 patients included in this study, 36 patients were hypo-responders and 26 patients were responders. Hemorrhagic events occurred 7.7% only in responders in the acute phase (p = 0.17), and 2.78% in hypo-responders and 23.1% in responders in the delayed phase (p = 0.02). Changes in hemoglobin levels before and after the procedure were 1.21 g/dl in hypo-responders and 1.92 g/dl in responders (p = 0.02) while before the procedure and chronic stages they were 0.39g/dl in hypo-responders and 1.41 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups.CONCLUSION: Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Long-term Complications After Stent Assist Coiling Dependent on Clopidogrel Response

Shoda

Enomoto

Egashira

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Although some studies of stent assisted coiling reported an association of hemorrhagic and thrombotic events with PRU values in the acute phase [ 17 – 21 ], there are few studies of an association between platelet reactivity and these events in the delayed phase after stent assisted coiling. Goh et al reported that evaluating hemorrhagic events up to 6 weeks after endovascular stenting treatment indicated that patients with > 72% PRU inhibition had more major bleeding than those with PRU < 72% [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term complications after stent assist coiling dependent on clopidogrel response

et al. 2021

View full text Add to dashboard Cite

Background Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. Methods Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter). Results From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups. Conclusion Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.

show abstract

“…Higashiguchi et al indicated that personalized dual antiplatelet therapy based on a platelet reaction unit (PRU) cutoff value of 240 significantly reduced thromboembolic complications without increasing hemorrhagic complications [ 17 ] during the endovascular period. However, limited information exists regarding the efficacy of antiplatelet modification based on the Verifynow P2Y 12 platelet function test [ 18 ]. Therefore, the aim of our study was to investigate the clinical outcomes associated with platelet function test-guided clopidogrel modification in patients with ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Verifynow P2Y12 PRU-Guided Modification of Clopidogrel for Prevention of Recurrent Ischemic Stroke: A Real-World Prospective Cohort Study

Zhang

Qiao

2022

Neurol Ther

View full text Add to dashboard Cite

Introduction: Clopidogrel resistance causes recurrent stroke. However, outcomes of modified antiplatelet medications to prevent recurrent ischemic stroke are not well known. Methods: Patients who received clopidogrel with and without modification as initial treatment for stroke were recruited and compared. The primary outcome was ischemic stroke and myocardial infarction at the 1-year follow-up. The secondary outcome was bleeding complications. Results: Overall, 206 patients treated with clopidogrel were enrolled and were divided into the modification (n = 39) and no modification (n = 167) groups. There was a significant difference in the incidence of severe cerebral arterial stenosis between the two groups (modification group, 16/39, 41.03%; no modification group, 36/167, 21.56%, P = 0.012) at baseline. The loss to follow-up rate was 12.14% (25/206). After adjustment for severe cerebral artery stenosis, antiplatelet modification based on the platelet reactivity unit (PRU) value significantly improved in the per protocol set (odds ratio 0.142, 95% confidential interval 0.022-0.898, P = 0.038). The area under the curve of the different PRU cutoff values were 0.630, 0.605, and 0.591 (P = 0.016, 0.051, and 0.092) for PRU 190, 208, and 235, respectively. Conclusion: Verifynow P2Y 12 PRU-guided modification of clopidogrel for ischemic stroke significantly improved or prevented recurrence at the 1-year follow-up. Our findings suggest that clopidogrel therapy based on the PRU cutoff value of 190 should be considered to improve outcomes. Trial Registration: ClinicalTrials.gov NCT02618265 (December 1, 2015).

show abstract

The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysis

Cited by 8 publications

References 39 publications

WITHDRAWN: Long-term Complications After Stent Assist Coiling Dependent on Clopidogrel Response

WITHDRAWN: Long-term Complications After Stent Assist Coiling Dependent on Clopidogrel Response

Long-term complications after stent assist coiling dependent on clopidogrel response

Verifynow P2Y12 PRU-Guided Modification of Clopidogrel for Prevention of Recurrent Ischemic Stroke: A Real-World Prospective Cohort Study

Contact Info

Product

Resources

About