Document Detail


[Resistance to antiplatelet agents assessed by a point-of-care platelet function test and thromboembolic adverse events in neurointervention].
MedLine Citation:
PMID:  22538281     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To clarify the frequency of Japanese patients who are resistant to antiplatelet agents, and then clarify correlations between resistance and thromboembolic adverse events in neurointervention.
METHODS: Blood samples were collected from 163 patients who were taking antiplatelet agents and received neurointervention, with 128 samples collected just before neurointervention. Residual platelet function was measured using a point-of-care platelet function test, VerifyNow®, and then the frequency of patients resistant to drugs (low-responders), correlations between resistance and thromboembolic events, and effects of adding cilostazol to clopidogrel administration were analyzed. Cut-off values were defined as 550 Aspirin Reaction Units (ARU), 230 P2Y12 Reaction Units (PRU), and 50%inhibition of P2Y12, respectively.
RESULTS: Three of 105 patients (2.9%) taking aspirin at 100 mg/day were low-responders, whereas 48 (41.0%, as measured by PRU) or 80 (68.4%, as measured by %inhibition) of 117 patients taking clopidogrel at 75 mg/day were low-responders. Among the 19 patients taking cilostazol 200 mg/day in addition to clopidogrel 75 mg/day, platelet functions were significantly more strongly inhibited compared to patients taking clopidogrel alone (p=0.02 by PRU, p=0.005 by %inhibition). Thromboembolic adverse events occurred in 7 patients. Among these 7 patients, 6 who were taking aspirin were all responders to aspirin, while 4 of the 6 patients taking clopidogrel were low-responders to clopidogrel. In 69 patients who received aneurysmal transarterial embolization, 2 thromboembolic complications occurred among low-responders (p=0.09).
CONCLUSION: Aspirin resistance is rare in Japanese individuals. With aneurysmal transarterial embolization, thromboembolic events tended to occur among clopidogrel low-responders. Addition of cilostazol may offer one method of overcoming clopidogrel resistance.
Authors:
Kenichi Haraguchi; Shigeru Miyachi; Takashi Izumi; Noriaki Matsubara; Takehiro Naito; Takumi Asai; Takashi Yamanouchi; Toshihiko Wakabayashi
Publication Detail:
Type:  English Abstract; Journal Article    
Journal Detail:
Title:  No shinkei geka. Neurological surgery     Volume:  40     ISSN:  0301-2603     ISO Abbreviation:  No Shinkei Geka     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-27     Completed Date:  2012-07-17     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  0377015     Medline TA:  No Shinkei Geka     Country:  Japan    
Other Details:
Languages:  jpn     Pagination:  399-406     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aspirin / pharmacology
Drug Resistance
Female
Humans
Intracranial Aneurysm / drug therapy
Male
Middle Aged
Platelet Aggregation Inhibitors / pharmacology*,  therapeutic use
Platelet Function Tests / methods*
Point-of-Care Systems*
Tetrazoles / therapeutic use
Thromboembolism / etiology*
Ticlopidine / analogs & derivatives,  pharmacology
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 0/Tetrazoles; A74586SNO7/clopidogrel; N7Z035406B/cilostazol; OM90ZUW7M1/Ticlopidine; R16CO5Y76E/Aspirin

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