Advanced

AJNR - American Journal of Neuroradiology

Published ahead of print on May 15, 2008
doi: 10.3174/ajnr.A1070

This Article Figures Only Full Text Full Text (PDF) Supplemental Online Table All Versions of this Article: ajnr.A1070v1 29/7/1389    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Lee, D.H. Articles by Mawad, M.E. Search for Related Content PubMed PubMed Citation Articles by Lee, D.H. Articles by Mawad, M.E.

American Journal of Neuroradiology 29:1389-1394, August 2008
© 2008 American Society of Neuroradiology

INTERVENTIONAL

Dual Antiplatelet Therapy Monitoring for Neurointerventional Procedures Using a Point-of-Care Platelet Function Test: A Single-Center Experience

D.H. Lee^a,b, A. Arat^b, H. Morsi^b, H. Shaltoni^b, J.R. Harris^c and M.E. Mawad^b

^a Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
^b Department of Radiology, Baylor College of Medicine, Houston, Tex
^c Accumetrics Inc, San Diego, Calif

Please address correspondence to Deok Hee Lee, MD, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea; e-mail: dhlee{at}amc.seoul.kr

BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures.

MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5–10 days before the procedure. The test results were reported as aspirin-reaction unit (ARU) for aspirin and P2Y₁₂ reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y₁₂ assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded.

RESULTS: The mean ARU of aspirin assays was 438.3 ± 47.9 (range, 350–632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234–495), 198.9 ± 104.4 (range, 8–401), and 45.2 ± 27.1% (range, 0–98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group.

CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.

This article has been cited by other articles:

				D Heck Incidence and time course of carotid in-stent restenosis in a consecutive series of 295 patients JNIS, July 3, 2009; (2009) jnis.2009.000349v1. [Abstract] [Full Text] [PDF]

				S. Chaturvedi and A. S. Dumont The learning curve for neuroendovascular procedures: How important is it? Neurology, June 9, 2009; 72(23): 1974 - 1975. [Full Text] [PDF]

				A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. [Abstract] [Full Text] [PDF]