Preinterventional clopidogrel response variability for coil embolization of intracranial aneurysms: clinical implications.
OBJECTIVE
Thromboembolism is one of the most serious complications in coil embolization for intracranial aneurysms, and antiplatelet premedication may reduce this complication. However, interindividual variation exists in the efficacy of CPG. This study sought to elucidate the clinical implications of preinterventional CPG response variability in patients who undergo coil embolization for intracranial aneurysms.


METHODS
CPG premedication was given to 186 consecutive patients with 209 aneurysms who underwent elective coil embolization, and the response to the premedication was measured by a point-of-care antiplatelet function test (VerifyNow assay). Patients were stratified into 4 quartiles according the test results, and their correlation with the occurrence of periprocedural complications was analyzed. The contribution of a variety of variables to the high PRU was also tested.


RESULTS
In this cohort, rates of thromboembolic events and all adverse events were 7.5% and 9.1%, respectively. The quartiles of the P2Y12 reaction unit of the ADP channel (PRU) showed a significant tendency toward thromboembolic events (P = .013) and all procedure-related adverse events (P = .009), while those of the BASE and percentage inhibition did not. Thromboembolic events occurred in 17.0% and procedure-related adverse events, in 21.3% of the patients in the fourth quartile. Female sex was the only significant factor related to the fourth quartile of PRU in the multiple logistic regression analysis (P = .014).


CONCLUSIONS
Procedure-related thromboembolic events occurred more frequently in patients in the upper quartile with higher PRU, especially in the fourth quartile. Further study including a large number of patients is expected to confirm this finding.
Department of Neurosurgery, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea.
H-S
HS
Kang
B J
BJ
Kwon
J E
JE
Kim
Moon Hee
MH
Han
D000368:Aged; D001780:Blood Coagulation Tests / Q000379:methods; D000077144:Clopidogrel; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000628:therapy*; D020767:Intracranial Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine