Long-term complications after stent assist coiling dependent on clopidogrel response

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Kenji Shoda1, Yukiko Enomoto2, Yusuke Egashira2

  • 1Department of Neurosurgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan. sho_ken@gifu-u.ac.jp.

BMC Neurology
|June 29, 2021
PubMed

Insights

Dual antiplatelet therapy (DAPT) after stent-assisted coiling is linked to delayed hemorrhagic events, particularly in clopidogrel responders. Careful consideration of DAPT duration is crucial to prevent these complications.

Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Cardiology

Background:

  • Dual antiplatelet therapy (DAPT) is essential for stent-assisted coiling procedures.
  • Long-term DAPT use carries a risk of hemorrhagic complications.
  • Understanding clopidogrel reactivity is key to managing these risks.

Purpose of the Study:

  • To investigate the relationship between clopidogrel reactivity and post-procedure complications.
  • To compare hemorrhagic and thrombotic event rates in patients with different clopidogrel response levels.
  • To assess the impact of clopidogrel response on hemoglobin levels post-procedure.

Main Methods:

  • Retrospective analysis of 61 patients undergoing stent-assisted coiling with DAPT.
  • Clopidogrel reactivity assessed using VerifyNow assay, defining hypo-responders (PRU≥208) and responders (PRU<208).
  • Comparison of acute (≤30 days) and delayed (>30 days) hemorrhagic/thrombotic events and hemoglobin changes.

Main Results:

  • Hemorrhagic events occurred more frequently in responders during the delayed phase (20.0% vs. 2.78%, p=0.037).
  • Significant hemoglobin drops were observed in responders compared to hypo-responders in both acute and chronic phases.
  • No significant difference in thrombotic events was found between the groups.

Conclusions:

  • Long-term DAPT following stent-assisted coiling is associated with delayed hemorrhagic events.
  • Clopidogrel responders are at higher risk for these delayed hemorrhagic events.
  • DAPT duration requires careful consideration in clopidogrel responders to mitigate hemorrhagic risks.
Abstract

Keywords:
Chronic phaseDual antiplatelet therapyHemorrhagic eventsStent assisted coiling

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