Abstract：
BACKGROUND: Dual antiplatelet therapy is used to reduce the risk of thromboembolic complications in neuroendovascular surgery. However, the predictive utility of preoperative platelet-sensitivity testing for decreasing bleed risk in patients undergoing endovascular neurointervention remains unclear.
OBJECTIVE: We conducted a systematic review and meta-analysis to illustrate the association between platelet response and risk of hemorrhagic complications from neuroendovascular surgery, examine the efficacy of the VerifyNow platelet reactivity unit (PRU) assay in predicting hemorrhagic outcomes, and assess whether a clinically useful threshold for platelet response can be defined to standardize guidelines.
METHODS: PubMed, Embase, and Scopus were searched. Articles were screened for relevance by title and abstract, followed by full text.
RESULTS: Of 735 resultant articles, 17 studies of 2084 patients undergoing neuroendovascular intervention were included. Diagnoses included both intracranial and extracranial pathologies, of which 37.8% were treated with flow diversion, 22.4% with stent-assisted coil embolization, 14.3% with intracranial stenting, 12.8% with simple coil embolization, 5.8% with balloon-assisted coil embolization, 2.0% with extracranial stenting, and 4.8% with an alternate method. Precisely, 52.9% (9 out of 17) of studies determined platelet hyperresponse to be an independent predictor of postoperative hemorrhagic complications, with 11.8% (2 out of 17) of studies reporting a similar but non-statistically significant trend. 35.3% (6 out of 17) of studies found no relationship between platelet response and postoperative hemorrhagic complications. The estimated clinical threshold for PRU to prevent hemorrhagic complications varied considerably across studies (range: <46-118 PRU). Meta-analysis found platelet hyperresponse to have more than a 3-fold increased risk of hemorrhagic complications compared to normoresponders (relative risk = 3.2, p = 0.001).
CONCLUSIONS: Although this meta-analysis shows the predictive utility of the P2Y12 assay for postoperative hemorrhagic complications in neuroendovascular surgery, the optimal therapeutic threshold for minimizing bleeding risk is still uncertain. To better understand the utility of the P2Y12 assay in the perioperative period, further prospective research is needed.
OBJECTIVE: We conducted a systematic review and meta-analysis to illustrate the association between platelet response and risk of hemorrhagic complications from neuroendovascular surgery, examine the efficacy of the VerifyNow platelet reactivity unit (PRU) assay in predicting hemorrhagic outcomes, and assess whether a clinically useful threshold for platelet response can be defined to standardize guidelines.
METHODS: PubMed, Embase, and Scopus were searched. Articles were screened for relevance by title and abstract, followed by full text.
RESULTS: Of 735 resultant articles, 17 studies of 2084 patients undergoing neuroendovascular intervention were included. Diagnoses included both intracranial and extracranial pathologies, of which 37.8% were treated with flow diversion, 22.4% with stent-assisted coil embolization, 14.3% with intracranial stenting, 12.8% with simple coil embolization, 5.8% with balloon-assisted coil embolization, 2.0% with extracranial stenting, and 4.8% with an alternate method. Precisely, 52.9% (9 out of 17) of studies determined platelet hyperresponse to be an independent predictor of postoperative hemorrhagic complications, with 11.8% (2 out of 17) of studies reporting a similar but non-statistically significant trend. 35.3% (6 out of 17) of studies found no relationship between platelet response and postoperative hemorrhagic complications. The estimated clinical threshold for PRU to prevent hemorrhagic complications varied considerably across studies (range: <46-118 PRU). Meta-analysis found platelet hyperresponse to have more than a 3-fold increased risk of hemorrhagic complications compared to normoresponders (relative risk = 3.2, p = 0.001).
CONCLUSIONS: Although this meta-analysis shows the predictive utility of the P2Y12 assay for postoperative hemorrhagic complications in neuroendovascular surgery, the optimal therapeutic threshold for minimizing bleeding risk is still uncertain. To better understand the utility of the P2Y12 assay in the perioperative period, further prospective research is needed.
摘要：
背景：双重抗血小板治疗用于降低神经血管内手术中血栓栓塞并发症的风险。然而,术前血小板敏感性检测对降低血管内神经介入治疗患者出血风险的预测作用尚不清楚.
目的：我们进行了系统评价和荟萃分析，以说明血小板反应与神经血管内手术出血并发症风险之间的关系。检查VerifyNow血小板反应性单位（PRU）测定在预测出血性结局中的功效，并评估是否可以定义临床上有用的血小板反应阈值以标准化指南。
方法：PubMed，Embase,Scopus被搜查了.按标题和摘要筛选文章的相关性，其次是全文。
结果：在735篇文章中，纳入了2084例接受神经血管内介入治疗的患者的17项研究。诊断包括颅内和颅外病理，其中37.8%采用分流处理，22.4%支架辅助线圈栓塞，14.3%颅内支架置入术，12.8％，简单的线圈栓塞，球囊辅助线圈栓塞的5.8%，2.0%颅外支架置入术，和4.8%的替代方法。准确地说，52.9%（17项研究中有9项）的研究确定血小板高反应是术后出血并发症的独立预测因子，11.8%(17项研究中有2项)的研究报告了相似但无统计学意义的趋势。35.3%（17个中的6个）的研究发现血小板反应与术后出血并发症之间没有关系。PRU预防出血性并发症的估计临床阈值在研究中差异很大（范围：<46-118PRU）。荟萃分析发现，与正常反应者相比，血小板过度反应出血性并发症的风险增加了3倍以上（相对风险=3.2，p=0.001）。
结论：虽然这项荟萃分析显示了P2Y12测定对神经血管内手术术后出血并发症的预测效用，降低出血风险的最佳治疗阈值仍不确定.为了更好地了解P2Y12测定在围手术期的实用性，需要进一步的前瞻性研究。
目的：我们进行了系统评价和荟萃分析，以说明血小板反应与神经血管内手术出血并发症风险之间的关系。检查VerifyNow血小板反应性单位（PRU）测定在预测出血性结局中的功效，并评估是否可以定义临床上有用的血小板反应阈值以标准化指南。
方法：PubMed，Embase,Scopus被搜查了.按标题和摘要筛选文章的相关性，其次是全文。
结果：在735篇文章中，纳入了2084例接受神经血管内介入治疗的患者的17项研究。诊断包括颅内和颅外病理，其中37.8%采用分流处理，22.4%支架辅助线圈栓塞，14.3%颅内支架置入术，12.8％，简单的线圈栓塞，球囊辅助线圈栓塞的5.8%，2.0%颅外支架置入术，和4.8%的替代方法。准确地说，52.9%（17项研究中有9项）的研究确定血小板高反应是术后出血并发症的独立预测因子，11.8%(17项研究中有2项)的研究报告了相似但无统计学意义的趋势。35.3%（17个中的6个）的研究发现血小板反应与术后出血并发症之间没有关系。PRU预防出血性并发症的估计临床阈值在研究中差异很大（范围：<46-118PRU）。荟萃分析发现，与正常反应者相比，血小板过度反应出血性并发症的风险增加了3倍以上（相对风险=3.2，p=0.001）。
结论：虽然这项荟萃分析显示了P2Y12测定对神经血管内手术术后出血并发症的预测效用，降低出血风险的最佳治疗阈值仍不确定.为了更好地了解P2Y12测定在围手术期的实用性，需要进一步的前瞻性研究。
