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Platelet function testing in neurovascular procedures: Tool or Gimmick?

Citation

Cheung, NK and Carr, MW and Ray, U and McKenzie, D and Froelich, JJ, Platelet function testing in neurovascular procedures: Tool or Gimmick?, Interventional Neurology, 8 pp. 123-134. ISSN 1664-9737 (2019) [Refereed Article]

Copyright Statement

2019 S. Karger AG, Basel

DOI: doi:10.1159/000496702

Abstract

Background: Platelet inhibitors are used to prevent thromboembolic complications related to neurovascular stenting (NVS) procedures. Despite substantial inter-individual variability of functional platelet inhibition, the value of platelet function tests (PFT) to assess inhibition remains controversial.

Objective: This study was conducted to compare differences in thromboembolic complication rates associated with NVS in platelet-inhibited patients with and without PFT. Clinical neurological outcomes were assessed by differences in the modified Rankin Scale (mRS).

Materials and Methods: One hundred seventeen consecutive patients underwent elective NVS procedures within a 7-year period. All patients received aspirin and clopidogrel 8 days before the procedure. Fifty-Two patients were treated without assessment of platelet inhibition, and 65 patients were tested for clopidogrel resistance. When clopidogrel resistance was revealed, corresponding patients were converted to ticagrelor. Changes in mRS and thromboembolic event rates were compared between the 2 cohorts.

Results: Thirty-five percent of patients from the cohort subjected to PFT tests showed inadequate platelet inhi-bition under clopidogrel and were converted to ticagrelor. Compared to the non-PFT test-cohort, neurological deficits were significantly reduced (12 vs. 0%; p = 0.009) and a lower number of thromboembolic events was found (12 vs. 3%; p > 0.05) within the test cohort.

Conclusion: PFT appears to identify patients with clopidogrel resistance prior to NVS procedures. When non-responders are converted to alternative platelet inhibitors, neurological outcomes and thromboembolic complication rates may improve. Consequently, this study provides preliminary evidence that PFT may be a useful clinical tool to enhance procedural safety and improve clinical outcomes in NVS procedures.

Item Details

Item Type:Refereed Article
Keywords:platelet function testing, platelet inhibition, neurovascular stenting, intracranial aneurysms, coiling
Research Division:Medical and Health Sciences
Research Group:Neurosciences
Research Field:Neurology and Neuromuscular Diseases
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Nervous System and Disorders
UTAS Author:Cheung, NK (Dr Nicholas Cheung)
UTAS Author:Ray, U (Associate Professor Udayan Ray)
UTAS Author:Froelich, JJ (Professor Jens Froelich)
ID Code:133982
Year Published:2019
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-07-18
Last Modified:2019-08-13
Downloads:0

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