Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: A single-center experience

Deok Hee Lee, A. Arat, H. Morsi, Hashem Shaltoni, J. R. Harris, M. E. Mawad

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as aspirin-reaction unit (ARU) for aspirin and P2Y12 reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of aspirin assays was 438.3 ± 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234-495), 198.9 ± 104.4 (range, 8-401), and 45.2 ± 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.

Original languageEnglish (US)
Pages (from-to)1389-1394
Number of pages6
JournalAmerican Journal of Neuroradiology
Volume29
Issue number7
DOIs
StatePublished - Aug 1 2008
Externally publishedYes

Fingerprint

clopidogrel
Platelet Function Tests
Point-of-Care Systems
Aspirin
Therapeutics
Drug Monitoring
Thrombosis
Multivariate Analysis
Body Weight

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test : A single-center experience. / Lee, Deok Hee; Arat, A.; Morsi, H.; Shaltoni, Hashem; Harris, J. R.; Mawad, M. E.

In: American Journal of Neuroradiology, Vol. 29, No. 7, 01.08.2008, p. 1389-1394.

Research output: Contribution to journalArticle

@article{62955079d4d24225b3a592873997d660,
title = "Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: A single-center experience",
abstract = "BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as aspirin-reaction unit (ARU) for aspirin and P2Y12 reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40{\%} inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of aspirin assays was 438.3 ± 47.9 (range, 350-632), and the response was poor in 2 patients (2.1{\%}). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234-495), 198.9 ± 104.4 (range, 8-401), and 45.2 ± 27.1{\%} (range, 0-98), respectively. Forty-two patients (42.9{\%}) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1{\%}) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.",
author = "Lee, {Deok Hee} and A. Arat and H. Morsi and Hashem Shaltoni and Harris, {J. R.} and Mawad, {M. E.}",
year = "2008",
month = "8",
day = "1",
doi = "10.3174/ajnr.A1070",
language = "English (US)",
volume = "29",
pages = "1389--1394",
journal = "American Journal of Neuroradiology",
issn = "0195-6108",
publisher = "American Society of Neuroradiology",
number = "7",

}

TY - JOUR

T1 - Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test

T2 - A single-center experience

AU - Lee, Deok Hee

AU - Arat, A.

AU - Morsi, H.

AU - Shaltoni, Hashem

AU - Harris, J. R.

AU - Mawad, M. E.

PY - 2008/8/1

Y1 - 2008/8/1

N2 - BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as aspirin-reaction unit (ARU) for aspirin and P2Y12 reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of aspirin assays was 438.3 ± 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234-495), 198.9 ± 104.4 (range, 8-401), and 45.2 ± 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.

AB - BACKGROUND AND PURPOSE: Growing evidence of the relationship between poor antiplatelet response and occurrence of clinical events elicited the need of monitoring the response which has not been part of our daily practice. We present our initial experience with a new point-of-care antiplatelet-function test (VerifyNow assay) in neurointerventional procedures. MATERIALS AND METHODS: Among the 106 consecutive patients from July 2006 to April 2007, ninety-eight met the inclusion criteria. Our preferred antiplatelet regimen was aspirin (325 mg daily) and clopidogrel (300 mg of loading dose followed by 75 mg daily) starting 5-10 days before the procedure. The test results were reported as aspirin-reaction unit (ARU) for aspirin and P2Y12 reaction units (PRU), baseline (BASE), and percentage inhibition for the P2Y12 assay and were summarized as mean ± SD of the values. We analyzed the effects of several factors of poor clopidogrel response (<40% inhibition). The occurrence of thrombotic events was recorded. RESULTS: The mean ARU of aspirin assays was 438.3 ± 47.9 (range, 350-632), and the response was poor in 2 patients (2.1%). For clopidogrel, the mean of the BASE, PRU, and percentage inhibition was 356.8 ± 56.3 (range, 234-495), 198.9 ± 104.4 (range, 8-401), and 45.2 ± 27.1% (range, 0-98), respectively. Forty-two patients (42.9%) showed poor response. Multivariate analysis showed greater body weight (81.9 Kg ± 19.1 kg versus 69.9 ± 15 kg) in the poor-response group. All 3 cases of intraprocedural thrombosis (3.1%) were observed only in the poor-response group. CONCLUSION: We observed a high frequency of poor clopidogrel responses in the neurointerventional setting. Routine monitoring of the drug response would be helpful for the early identification of poor antiplatelet responders so that we may modify the regimen and/or treatment plan.

UR - http://www.scopus.com/inward/record.url?scp=49749114862&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=49749114862&partnerID=8YFLogxK

U2 - 10.3174/ajnr.A1070

DO - 10.3174/ajnr.A1070

M3 - Article

C2 - 18483190

AN - SCOPUS:49749114862

VL - 29

SP - 1389

EP - 1394

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 7

ER -