Antiplatelet Premedication for Stent-Assisted Coil Embolization of Intracranial Aneurysms: Low-Dose Prasugrel vs Clopidogrel.

Abstract

BACKGROUND:

The use of antiplatelet medications to prevent thrombosis in the treatment of cerebral aneurysms with stents has become widely emphasized.

OBJECTIVE:

To compare low-dose prasugrel with clopidogrel in stent-assisted coil embolization of intracranial aneurysms.

METHODS:

This is a retrospective review of 311 aneurysms from 297 patients who underwent stent-assisted endovascular coil embolization of unruptured intracranial aneurysm between November 2014 and March 2017. Thromboembolic and hemorrhagic adverse events were compared between 207 patients who received low-dose prasugrel (PSG group) and 90 patients who received clopidogrel (CPG group).

RESULTS:

P2Y12 reaction unit (PRU) values were significantly lower in the PSG group (PSG group vs CPG group, 132.3 ± 76.9 vs 238.1 ± 69.1; P < .001); the percentage of inhibition was also statistically higher in the PSG group (54.0 ± 26.0% vs 20.8 ± 18.6%; P < .001). Thromboembolic events occurred less frequently in the PSG group than in the CPG group (0.9% vs 6.4%; P = .01), whereas there was no significant difference in the percentage of hemorrhagic complications (0.5% vs 2.2%; P = .22). In the multivariate analysis, clopidogrel as the antiplatelet medication was the sole significant risk factor for thromboembolism in this series of patients undergoing stent-assisted coil embolization.

CONCLUSION:

Use of low-dose PSG as an antiplatelet premedication is quick, effective, and safe for stent-assisted coil embolization of unruptured intracranial aneurysms. Prasugrel premedication significantly lowered the frequency of thromboembolic events without increasing the risk of hemorrhage.

• Authors: Hyun Ho Choi, Jung Jun Lee, Young Dae Cho, Moon Hee Han, Won-Sang Cho, Jeong Eun Kim, Sang Joon An, Jong Hyeon Mun, Dong Hyun Yoo, Hyun-Seung Kang
• Journal: Neurosurgery (Neurosurgery) Vol. 83 Issue 5 Pg. 981-988 (11 01 2018) ISSN: 1524-4040 [Electronic] United States
• PMID: 29301051 (Publication Type: Journal Article)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Prasugrel Hydrochloride

Topics

• Adult
• Aged
• Clopidogrel (therapeutic use)
• Embolization, Therapeutic (adverse effects)
• Endovascular Procedures (adverse effects)
• Female
• Humans
• Intracranial Aneurysm (complications, surgery)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Prasugrel Hydrochloride (therapeutic use)
• Premedication (methods)
• Retrospective Studies
• Risk Factors
• Stents
• Thromboembolism (etiology, prevention & control)