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Updated: May 22, 2026

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
10:28

Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function

Published on: March 15, 2022

Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures

S Hassan Akbari1, Matthew R Reynolds, Yasha Kadkhodayan

  • 1Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA.

Journal of Neurointerventional Surgery
|May 5, 2012
PubMed

Insights

Dual antiplatelet therapy (DAPT) with aspirin and prasugrel may increase hemorrhage risk in neurointerventional surgery compared to aspirin and clopidogrel. This finding is crucial for patient safety and treatment selection in these procedures.

Area of Science:

  • Neurosurgery
  • Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) with aspirin and a thienopyridine is standard for preventing thromboembolic events in neurointerventional surgery.
  • Clopidogrel resistance is common, leading to interest in alternative agents like prasugrel.
  • Limited data exist on prasugrel's safety and efficacy in neurointerventional procedures.

Observation:

  • A retrospective review of 76 patients undergoing neurointerventional surgery was conducted.
  • Patients received either aspirin/clopidogrel or aspirin/prasugrel DAPT.
  • Patients on aspirin/prasugrel were pre-identified clopidogrel non-responders.

Findings:

  • Hemorrhagic complications occurred in 19.4% of patients on aspirin/prasugrel versus 3.6% on aspirin/clopidogrel (p=0.02).
  • No significant differences in thrombotic complications were observed between the groups.
  • Hemorrhage rates per procedure type were similar between treatment groups.

Implications:

  • Aspirin/prasugrel DAPT may be associated with an increased risk of hemorrhage in neurointerventional surgery.
  • These findings necessitate careful consideration of DAPT regimens in patients undergoing these procedures.
  • Further research is warranted to optimize antiplatelet strategies in neurointerventional surgery.
Abstract

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