Precision of VerifyNow P2Y12 Assessment of Clopidogrel Response in Patients Undergoing Cerebral Aneurysm Flow Diversion

Neurosurgery
Matthew T BenderAlexander L Coon

Abstract

Dual antiplatelet therapy (DAT), most commonly with aspirin and Clopidogrel, is the standard of care for intracranial stenting, including flow diversion. Clopidogrel response varies by individual. To investigate the real-world precision of VerifyNow P2Y12 assessment (Accumetrics, San Diego, California) of Clopidogrel response. Using a prospectively-collected, IRB-approved cerebral aneurysm database 643 patients were identified who were treated with the Pipeline embolization device from 2011 to 2017. Patients with multiple P2Y12 assays drawn within a 24-h window were identified. A single patient could contribute multiple, independent sets. Levels drawn before a 5-d course of DAT and patients who received alternative antiplatelet agents were excluded. Therapeutic range was defined as platelet reaction units (PRU) 60-200. A total of 1586 P2Y12 measurements were recorded; 293 (46%) patients had more than one assay. One hundred forty (22%) patients had multiple P2Y12 measurements within 24 h. These patients accounted for 230 independent 24-h sets. The average P2Y12 fluctuation across all sets was 35 points; the 25th, 50th, and 75th percentiles were 12, 26, and 48 points, respectively. Of the 230 24-h sets of P2Y12 assays, 76% remain...Continue Reading

References

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Sep 8, 2016·Journal of Neurointerventional Surgery·Matthew T BenderAlexander L Coon
Apr 16, 2017·Stroke; a Journal of Cerebral Circulation·Nimer AdeebAjith J Thomas

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Citations

Jul 6, 2019·Journal of Neurointerventional Surgery·Anna PodlasekMohammed A Almekhlafi
May 16, 2020·Stroke and Vascular Neurology·Jessica K CamposAlexander L Coon
Apr 13, 2021·Clinical Neuroradiology·Halitcan BaturAnil Arat
Jun 4, 2021·Journal of Neurointerventional Surgery·Timothy R MillerDheeraj Gandhi
Sep 27, 2021·World Neurosurgery·David I BassMichael R Levitt

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