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Related Experiment Video

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Dynamic Multiparameter Platelet Function Assessment Using a Capacitive Biosensor
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A 70-Year-Old Female with Unexpected Platelet Function Testing Results.

Moon Joo Kim1, Pragna Patel2, Niti Vyas1

  • 1Houston Methodist Hospital, Department of Pathology and Genomic Medicine, Houston, Texas.

Laboratory Medicine
|October 31, 2019
PubMed
Summary

This study reports a rare case of ticagrelor resistance in a patient undergoing Pipeline Embolization Device (PED) placement for a brain aneurysm. Switching to prasugrel successfully managed platelet reactivity, enabling safe procedure completion.

Keywords:
aneurysmanti-plateletcoagulationplateletresistanceticagrelor

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Area of Science:

  • Neuroendovascular surgery
  • Pharmacology
  • Cardiology

Background:

  • A 70-year-old female with hypertension and an A2 segment aneurysm was prepared for Pipeline Embolization Device (PED) placement.
  • Pre-procedural antiplatelet therapy consisted of aspirin and ticagrelor.

Observation:

  • VerifyNow testing revealed a significantly elevated P2Y12 reaction unit (PRU) of 216 after 13 days of ticagrelor, indicating substantial platelet reactivity.
  • Light transmission aggregometry confirmed ticagrelor resistance, a rare phenomenon, especially in the context of pre-PED placement.

Findings:

  • Antiplatelet therapy was switched to prasugrel while continuing aspirin.
  • Follow-up PRU values decreased to 164, demonstrating effective platelet inhibition with the new regimen.
  • The PED placement was successfully completed without complications.

Implications:

  • This case highlights the potential for ticagrelor resistance in patients undergoing neuroendovascular procedures.
  • It underscores the importance of monitoring antiplatelet response, particularly with direct P2Y12 inhibitors like ticagrelor.
  • Alternative antiplatelet strategies, such as prasugrel, may be necessary for patients exhibiting resistance to standard therapies.