由阿司匹林和氯吡格雷组成的双重抗血小板治疗是神经介入支架和血流转移的标准护理。血小板功能检测越来越多地用于识别对氯吡格雷有低反应或高反应的患者。替格瑞洛一直是用于此类患者的流行的替代抗血小板剂。我们评估了血小板功能检测在接受替格瑞洛和支架置入或血流转移的患者中的作用。
回顾性分析了2017年5月至2019年8月在美国一家学术机构接受替格瑞洛治疗的患者在治疗过程中的任何时间点接受支架辅助盘绕或管道分流治疗脑动脉瘤的数据。血小板功能测试用于确定P2Y12反应单位(PRU),结果与手术并发症相关。
在接受替格瑞洛治疗的同时,共治疗28例患者,其中29例动脉瘤。在29个动脉瘤中,16例(55.2%)用分流流处理,13例(44.8%)用支架辅助卷绕处理。血栓栓塞并发症4例(13.8%),未发生出血并发症。在≥1个PRU值>100的8例患者中,有4例(50%)出现血栓栓塞并发症。没有PRU值>100的患者没有经历任何并发症。
接受替格瑞洛治疗的患者存在血栓栓塞并发症的风险,这与本初步研究中的PRU相关。本研究的结果表明,接受替格瑞洛的患者的安全PRU范围应移至0-100,低于氯吡格雷,被认为是60-210。需要进一步验证接受替格瑞洛的患者的最佳PRU范围。
Dual antiplatelet therapy consisting of aspirin and clopidogrel is the standard of care for neurointerventional stenting and flow diversion. Platelet function testing has been increasingly performed to identify patients with a hypo- or hyper-response to clopidogrel. Ticagrelor has been a popular alternative antiplatelet agent for such patients. We assessed the role of platelet function testing in patients receiving ticagrelor and undergoing stenting or flow diversion.
The data from patients who had undergone stent-assisted coiling or Pipeline flow diversion of a cerebral aneurysm with ticagrelor therapy at any point during their treatment course from May 2017 to August 2019 at a single academic institution in the United States were retrospectively reviewed. Platelet function testing was used to determine the P2Y12 reactive units (PRUs), and the results were correlated with the procedural complications.
A total of 28 patients with 29 aneurysms were treated while receiving ticagrelor. Of the 29 aneurysms, 16 (55.2%) were treated with flow diversion and 13 (44.8%) with stent-assisted coiling. Four thromboembolic complications (13.8%) and no hemorrhagic complications developed. Of the 8 patients with ≥1 PRU value >100, 4 (50%) had experienced a thromboembolic complication. The patients without a PRU value >100 did not experience any complications.
A risk of thromboembolic complications exists for patients receiving ticagrelor, which correlated with the PRUs in the present preliminary study. The findings from the present study suggest that the safe PRU range for patients receiving ticagrelor should be shifted to 0-100, which is lower than that of clopidogrel, thought to be 60-210. Further validation of the optimal PRU range for patients receiving ticagrelor is necessary.