Antiplatelet Therapy and Platelet Activity Testing for Neurointerventional Procedures

Area of Science:

• Neuroscience
• Pharmacology
• Interventional Cardiology

Background:

• Antiplatelet medication management in neurointerventional procedures lacks standardization.
• Evidence from cardiac/peripheral vascular diseases is not directly transferable to neurointerventional settings.
• Interpatient variability in response to antiplatelet agents complicates treatment decisions.

Purpose of the Study:

• To review current clinical practices for antiplatelet therapy in neurointerventional procedures.
• To evaluate the impact of different antiplatelet regimens and platelet function testing on patient outcomes.
• To summarize expert consensus on managing antiplatelet therapy for neurointerventional procedures.

Main Methods:

• Literature review of antiplatelet therapies and platelet activity testing in neurointerventional settings.
• Analysis of clinical practices, including the use of clopidogrel, ticagrelor, prasugrel, cangrelor, and glycoprotein IIb/IIIa inhibitors.
• Summary of expert consensus guidelines for elective and emergent procedures.

Main Results:

• Significant variability exists in antiplatelet management strategies.
• Challenges with clopidogrel include genetic variability and drug interactions.
• Platelet function testing is common but lacks standardized assays, thresholds, and proven clinical utility.
• Alternative agents and intravenous inhibitors offer options for specific scenarios.

Conclusions:

• Optimal antiplatelet management for neurovascular procedures requires further investigation.
• Standardization of platelet function testing and development of evidence-based protocols are crucial.
• Multicenter studies are needed to optimize patient outcomes in neurointerventional settings.