title: Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy.
abstract: OBJECTIVE
  Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy.
  
  
  METHODS
  From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications.
  
  
  RESULTS
  A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications.
  
  
  CONCLUSIONS
  The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170-180 is predictive of hemorrhagic complications.
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Hidehisa
authors: H
authors: Nishi
authors: Department of Neurosurgery, Fujita Health University, Aichi, Japan.
authors: Ichiro
authors: I
authors: Nakahara
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Shoji
authors: S
authors: Matsumoto
authors: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors: Tetsuya
authors: T
authors: Hashimoto
authors: Department of Neurosurgery, Kochi Health Science Center, Kochi, Japan.
authors: Tsuyoshi
authors: T
authors: Ohta
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Nobutake
authors: N
authors: Sadamasa
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Ryota
authors: R
authors: Ishibashi
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Masanori
authors: M
authors: Gomi
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Makoto
authors: M
authors: Saka
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Haruka
authors: H
authors: Miyata
authors: Department of Neurosurgery, Fujita Health University, Aichi, Japan.
authors: Sadayoshi
authors: S
authors: Watanabe
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Takuya
authors: T
authors: Okata
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Kazutaka
authors: K
authors: Sonoda
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Junpei
authors: J
authors: Kouge
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Akira
authors: A
authors: Ishii
authors: Department of Neurosurgery, Kokura Memorial Hospital, Fukuoka, Japan.
authors: Izumi
authors: I
authors: Nagata
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Jun-Ichi
authors: J
authors: Kira
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000628:therapy*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D002532:Intracranial Aneurysm / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D010979:Platelet Function Tests; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D015607:Stents; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Drug; Hemorrhage; Intervention; Pharmacology