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Platelet-Function-Monitoring-Guided Therapy After Emergent Carotid Artery Stenting.

Magnus Peter Brammer Kreiberg1, Nicolaj Grønbæk Laugesen1, Andreas Hjelm Brandt2

  • 1Cerebrovascular Research Unit Rigshospitalet, Department of Neurology, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.

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|November 27, 2024
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Summary

Personalized antiplatelet therapy using platelet function monitoring in emergent carotid stenting (eCAS) improved patient outcomes. Switching clopidogrel non-responders to ticagrelor was safe and associated with better results.

Keywords:
carotid artery stentingclopidogrel resistanceplatelet function monitoringstrokethrombectomy

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Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Antiplatelet therapy post-emergent carotid stenting (eCAS) balances risks of intracerebral hemorrhage (ICH) and in-stent thrombosis (IST).
  • Platelet function monitoring may optimize antiplatelet strategies to reduce complications.

Purpose of the Study:

  • To assess the impact of personalized antiplatelet therapy guided by platelet function monitoring in eCAS patients.
  • To compare outcomes between patients treated with clopidogrel versus ticagrelor based on response.

Main Methods:

  • Retrospective observational study of 105 eCAS patients (2019-2021).
  • Peri-procedural eptifibatide followed by aspirin and clopidogrel.
  • Platelet function monitored using the Multiplate® Analyzer; non-responders switched to ticagrelor.
  • Primary outcome: favorable modified Rankin Scale (mRS) score (0-2) at 90 days.

Main Results:

  • 27% of patients were clopidogrel non-responders and switched to ticagrelor.
  • Favorable outcomes were more frequent in ticagrelor-treated patients (82%) vs. clopidogrel-treated patients (57%), p=0.036.
  • Ticagrelor treatment was significantly associated with favorable outcomes (OR=3.89, p=0.036).

Conclusions:

  • Approximately one in four eCAS patients exhibit clopidogrel non-response.
  • Personalized antiplatelet therapy by switching non-responders to ticagrelor is safe and improves outcomes in eCAS.
  • This strategy offers a potential improvement in managing antiplatelet therapy for eCAS patients.