title: Last-recorded P2Y12 reaction units value is strongly associated with thromboembolic and hemorrhagic complications occurring up to 6 months after treatment in patients with cerebral aneurysms treated with the pipeline embolization device.
abstract: OBJECTIVE
  A recent study identified a preprocedural P2Y12 reaction units value of <60 or >240 as a strong independent predictor of perioperative thromboembolic and hemorrhagic complications after treatment of cerebral aneurysms with the Pipeline Embolization Device. This study aimed to determine whether a last-recorded P2Y12 reaction units value of <60 or >240 predicts thromboembolic and hemorrhagic complications up to 6 months after treatment of cerebral aneurysms with the Pipeline Embolization Device in the same patient cohort.
  
  
  METHODS
  We recorded patient and aneurysm characteristics, P2Y12 receptor antagonist administered, P2Y12 reaction units value with VerifyNow, procedural variables, and thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures at our institution during an 8-month period. Complications causing a permanent disabling neurologic deficit or death were considered major. Multivariate regression analysis was performed to identify independent predictors of thromboembolic and hemorrhagic complications.
  
  
  RESULTS
  Forty-four patients underwent 48 Pipeline Embolization Device procedures at our institution during the study period. There were 11 thromboembolic and hemorrhagic complications up to 6 months after treatment in our cohort (22.9%), 5 of which were major (10.4%). A last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all (P = .002) and major (P = .03) thromboembolic and hemorrhagic complications in our cohort. Most patients (71%) required, on average, 2 adjustments to the dose or type of P2Y12 receptor antagonist to remain within the 60-240 target P2Y12 reaction units range.
  
  
  CONCLUSIONS
  In our cohort, a last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all and major thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures.
authors.affiliation: Division of Interventional Neuroradiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
authors.forename: J E
authors.initials: JE
authors.lastname: Delgado Almandoz
authors.forename: B M
authors.initials: BM
authors.lastname: Crandall
authors.forename: J M
authors.initials: JM
authors.lastname: Scholz
authors.forename: J L
authors.initials: JL
authors.lastname: Fease
authors.forename: R E
authors.initials: RE
authors.lastname: Anderson
authors.forename: Y
authors.initials: Y
authors.lastname: Kadkhodayan
authors.forename: D E
authors.initials: DE
authors.lastname: Tubman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood / Q000150:complications / Q000628:therapy*; D020766:Intracranial Embolism / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D020767:Intracranial Thrombosis / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D058925:Receptors, Purinergic P2Y12 / Q000097:blood*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C548576:P2RY12 protein, human; D058925:Receptors, Purinergic P2Y12