J Korean Neurosurg Soc.  2019 Jan;62(1):3-9. 10.3340/jkns.2018.0151.

Variability of Platelet Reactivity on Antiplatelet Therapy in Neurointervention Procedure

• Yi HJ
• Hwang G
• Lee BH

• KMID: 2434341
• DOI: http://doi.org/10.3340/jkns.2018.0151

Abstract

As more intracranial aneurysms and other cerebrovascular pathologies are treated with neurointervention procedure, thromboembolic events that frequently lead to serious neurological deficit or fatal outcomes are increasing. In order to prevent the thromboembolic events, antiplatelet therapy is used in most procedures including coil embolization, stenting, and flow diversion. However, because of variable individual pharmacodynamics responses to antiplatelet drugs, especially clopidogrel, it is difficult for clinicians to select the adequate antiplatelet regimen and its optimal dose. This article reviews the neurointervention literature related to antiplatelet therapy and suggests a strategy for tailoring antiplatelet therapy in individual patients undergoing neurointervention based on the results of platelet function testing.

Keyword

Aspirin; Clopidogrel; Platelet aggregation inhibitors; Platelet function tests

MeSH Terms

Aspirin
Blood Platelets*
Embolization, Therapeutic
Fatal Outcome
Humans
Intracranial Aneurysm
Pathology
Platelet Aggregation Inhibitors
Platelet Function Tests
Stents
Aspirin
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1. Suggested strategy for tailoring antiplatelet therapy based on results of the VerifyNow P2Y12 test (Accumetrics, San Diego, CA, USA). *When loading doses of aspirin and clopidogrel are used, VerifyNow P2Y12 is recommended 4 hours after administration. † For stenting for atherosclerotic stenosis or flow diversion, a cardiology guideline (208 PRU) may be selected for dividing platelet reactivity into high and optimal categories. ‡ Loading dose of prasugrel is based on pharmacodynamic studies for Korean population[26,31,46]). For patients with <60 kg or ≥75 years, prasugrel 20 mg and 5 mg are recommended as loading and maintenance doses, respectively. § For patients receiving the procedure without stent placement, daily antiplatelet therapy is not generally recommended after procedure. PRU : P2Y12 reaction units.

Reference

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