Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy

Hidehisa Nishi, Ichiro Nakahara, Shoji Matsumoto, Tetsuya Hashimoto, Tsuyoshi Ohta, Nobutake Sadamasa, Ryota Ishibashi, Masanori Gomi, Makoto Saka, Haruka Miyata, Sadayoshi Watanabe, Takuya Okata, Kazutaka Sonoda, Junpei Kouge, Akira Ishii, Izumi Nagata, Jun-Ichi Kira

Research output: Contribution to journalArticle

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Abstract

Background and purpose Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy. Methods From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications. Results A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications. Conclusions The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170-180 is predictive of hemorrhagic complications.

Original languageEnglish
Pages (from-to)949-953
Number of pages5
JournalJournal of neurointerventional surgery
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 1 2016

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Blood Platelets
Hemorrhage
Aspirin
clopidogrel
Intracranial Aneurysm
Therapeutics
Carotid Arteries
ROC Curve
Area Under Curve
Multivariate Analysis
Prospective Studies
Morbidity
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy. / Nishi, Hidehisa; Nakahara, Ichiro; Matsumoto, Shoji; Hashimoto, Tetsuya; Ohta, Tsuyoshi; Sadamasa, Nobutake; Ishibashi, Ryota; Gomi, Masanori; Saka, Makoto; Miyata, Haruka; Watanabe, Sadayoshi; Okata, Takuya; Sonoda, Kazutaka; Kouge, Junpei; Ishii, Akira; Nagata, Izumi; Kira, Jun-Ichi.

In: Journal of neurointerventional surgery, Vol. 8, No. 9, 01.09.2016, p. 949-953.

Research output: Contribution to journalArticle

Nishi, H, Nakahara, I, Matsumoto, S, Hashimoto, T, Ohta, T, Sadamasa, N, Ishibashi, R, Gomi, M, Saka, M, Miyata, H, Watanabe, S, Okata, T, Sonoda, K, Kouge, J, Ishii, A, Nagata, I & Kira, J-I 2016, 'Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy', Journal of neurointerventional surgery, vol. 8, no. 9, pp. 949-953. https://doi.org/10.1136/neurintsurg-2015-011844
Nishi, Hidehisa ; Nakahara, Ichiro ; Matsumoto, Shoji ; Hashimoto, Tetsuya ; Ohta, Tsuyoshi ; Sadamasa, Nobutake ; Ishibashi, Ryota ; Gomi, Masanori ; Saka, Makoto ; Miyata, Haruka ; Watanabe, Sadayoshi ; Okata, Takuya ; Sonoda, Kazutaka ; Kouge, Junpei ; Ishii, Akira ; Nagata, Izumi ; Kira, Jun-Ichi. / Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy. In: Journal of neurointerventional surgery. 2016 ; Vol. 8, No. 9. pp. 949-953.
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abstract = "Background and purpose Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy. Methods From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications. Results A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1{\%}) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0{\%} in this group and 8.9{\%} in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications. Conclusions The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170-180 is predictive of hemorrhagic complications.",
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T1 - Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy

AU - Nishi, Hidehisa

AU - Nakahara, Ichiro

AU - Matsumoto, Shoji

AU - Hashimoto, Tetsuya

AU - Ohta, Tsuyoshi

AU - Sadamasa, Nobutake

AU - Ishibashi, Ryota

AU - Gomi, Masanori

AU - Saka, Makoto

AU - Miyata, Haruka

AU - Watanabe, Sadayoshi

AU - Okata, Takuya

AU - Sonoda, Kazutaka

AU - Kouge, Junpei

AU - Ishii, Akira

AU - Nagata, Izumi

AU - Kira, Jun-Ichi

PY - 2016/9/1

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N2 - Background and purpose Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy. Methods From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications. Results A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications. Conclusions The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170-180 is predictive of hemorrhagic complications.

AB - Background and purpose Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy. Methods From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications. Results A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications. Conclusions The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170-180 is predictive of hemorrhagic complications.

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