title: Optimal pediatric dosing of anti-platelet agents for pipeline stent embolization -a case report and review of the literature.
abstract: BACKGROUND
  Various strategies are emerging for dosing antiplatelet therapies in preparation for pipeline stent embolization in adults. Hyper-response is associated with hemorrhagic complications. Hypo-response is associated with thromboembolic events. Dosing of antiplatelet agents is highly variable, with little consensus among experts for adults-and even more so for children. To date, pipeline stents have been deployed in 11 pediatric patients, ages 4-15. A variety of clopidogrel and aspirin dosing regimens have been used, with response tested in only three patients, who were all therapeutic. Thrombotic events occurred in two patients, neither of whom were tested.
  
  
  METHODS
  We describe here the first case of a hemorrhagic complication in a hyper-responsive pediatric patient undergoing placement of a pipeline stent.
  
  
  CONCLUSIONS
  As the use of endovascular therapies requiring dual anti-platelet agents becomes more established, there is an increasing need to develop titration protocols that minimizes the risk of thrombotic and hemorrhagic events.
authors.affiliation: Department of Neurosurgery, Duke University Hospitals, DUMC Box 3807, Durham, NC, 27701, USA. maryih.cobb@duke.edu.
authors.forename: Mary In-Ping Huang
authors.identifier: http://orcid.org/0000-0001-8052-7854
authors.initials: MIH
authors.lastname: Cobb
authors.affiliation: Department of Neurosurgery, Duke University Hospitals, DUMC Box 3807, Durham, NC, 27701, USA.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.affiliation: Department of Neurosurgery, Duke University Hospitals, DUMC Box 3807, Durham, NC, 27701, USA.
authors.forename: Erik F
authors.initials: EF
authors.lastname: Hauck
authors.affiliation: Department of Radiology, Division of Interventional Radiology, Duke University Hospitals, Durham, NC, USA.
authors.forename: Tony P
authors.initials: TP
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Duke University Hospitals, DUMC Box 3807, Durham, NC, 27701, USA.
authors.forename: L
authors.initials: L
authors.lastname: Fernando Gonzalez
mesh_terms: D000293:Adolescent; D001241:Aspirin / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D000077144:Clopidogrel; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D018215:Osteoblastoma / Q000000981:diagnostic imaging / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Anti-platelet agents; Hemorrhagic complications; Optimal dosing anti-platelet agents; P2Y12; Pediatric dosing; Pipeline stent; Platelet response