title: Safety and efficacy of antiplatelet response assay and drug adjustment in coil embolization: a propensity score analysis.
abstract: BACKGROUND
  The purpose of this study was to explore the safety and efficacy of an antiplatelet response assay and drug adjustment to prevent delayed thromboembolic events after stent-assisted coil embolization.
  
  
  METHODS
  A total of 370 patients were enrolled in this study between December 2005 and July 2014. Of these, 124 patients were placed into the drug resistance test (DRT) group with drug adjustment according to response to an antiplatelet agent, and 246 patients comprised the control group with a standard antiplatelet regimen. The response to the antiplatelet agent was evaluated with the VerifyNow Rapid Platelet Function Assay. Propensity score matching analysis was performed with one-to-multiple matching.
  
  
  RESULTS
  Among 370 patients, delayed thromboembolic events occurred in 28 (7.6 %) patients including 25 (10.2 %) in the control group and three (2.4 %) in the DRT group. Antiplatelet response test (p = 0.012), diabetes mellitus (DM) (p = 0.014), and hypertension (HTN) (p < 0.001) were associated with delayed infarction in multivariate analysis. In propensity score matching analysis, 331 patients were matched (control group (n = 229) vs. DRT group (n = 103)), and antiplatelet response (hazard ratio 0.247, 95 % confidence interval 0.070-0.868, p = 0.029) was correlated with delayed infarction. Conversely, the two groups were not significantly different with regard to total (p = 0.368) or major hemorrhagic complications (p = 0.108).
  
  
  CONCLUSIONS
  Antiplatelet drug adjustment according to the results of an antiplatelet response assay might be associated with a decreased risk of delayed thromboembolic infarction compared with the standard antiplatelet regimen.
authors.affiliation: Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Hana General Hospital, Cheongju, South Korea.
authors.forename: Kyung Il
authors.initials: KI
authors.lastname: Jo
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
authors.forename: Je Young
authors.initials: JY
authors.lastname: Yeon
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Keon Ha
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Pyoung
authors.initials: P
authors.lastname: Jeon
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea. nsschong@skku.edu.
authors.forename: Seung Chyul
authors.initials: SC
authors.lastname: Hong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D015897:Comorbidity; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D057216:Propensity Score; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Aneurysm; Antiplatelet drug resistance; Interventional radiology; Stenting; Thromboembolism