Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
J Neurointerv Surg. 2014 May;6(4):320-2. doi: 10.1136/neurintsurg-2013-010699. Epub 2013 Jun 14.
Although platelet response testing is controversial, up to one-third of neuroendovascular patients are 'resistant' to clopidogrel and are at risk for in stent thrombotic complications and may require alternative antiplatelet therapy. Ticagrelor is a new reversible ADP P2Y12 platelet receptor inhibitor with no known resistance. We describe the clinical experience with ticagrelor for neuroendovascular procedures as an alternative in clopidogrel P2Y12 platelet resistant patients.
We reviewed our cerebrovascular database for all patients who were non-responders to clopidogrel, defined as P2Y12% inhibition <30%, despite repeat clopidogrel loading dose of at least 600 mg, and who were then administered ticagrelor.
18 patients were non-responders to clopidogrel; 10 (56%) were men, eight (44%) were women, with a median age of 61 years (range 38-84). All patients received loading doses of at least 600 mg of clopidogrel and showed P2Y12 levels below 20% prior to ticagrelor administration. Patients were loaded with 180 mg of ticagrelor, and all but one patient showed an initial P2Y12 response above 60%. 11 patients underwent stenting, two underwent coiling, and five underwent treatment by pipeline embolization device. No patient experienced any adverse effects in the postoperative period related to the use of ticagrelor.
Ticagrelor offers an effective alternative to clopidogrel non-responders. All of our patients showed immediate platelet inhibition after a loading dose of 180 mg of ticagrelor, with no adverse effects. The cost of medication, patient compliance (twice a day doses), and reversible inhibition should be taken into consideration when using ticagrelor.
尽管血小板反应测试存在争议，但多达三分之一的神经介入患者对氯吡格雷“耐药”，有发生支架内血栓并发症的风险，可能需要替代抗血小板治疗。替格瑞洛是一种新型可逆 ADP P2Y12 血小板受体抑制剂，目前尚无耐药性的报道。我们描述了替格瑞洛在氯吡格雷 P2Y12 血小板耐药患者中的神经介入应用经验，将其作为替代药物。
我们回顾了所有对氯吡格雷无反应的患者的脑血管数据库，对氯吡格雷无反应定义为重复给予至少 600mg 负荷剂量后 P2Y12 抑制率<30%，然后给予替格瑞洛。
18 例患者对氯吡格雷无反应；10 例（56%）为男性，8 例（44%）为女性，中位年龄为 61 岁（范围 38-84 岁）。所有患者均接受了至少 600mg 氯吡格雷的负荷剂量，在给予替格瑞洛之前 P2Y12 水平低于 20%。患者给予 180mg 替格瑞洛负荷剂量，除 1 例外，所有患者初始 P2Y12 反应均>60%。11 例患者接受支架置入术，2 例患者接受线圈栓塞术，5 例患者接受Pipeline 栓塞装置治疗。无患者在术后因使用替格瑞洛而出现任何不良反应。
替格瑞洛为氯吡格雷无反应患者提供了有效的替代治疗方案。所有患者在给予 180mg 替格瑞洛负荷剂量后即刻出现血小板抑制，无不良反应。在使用替格瑞洛时，应考虑药物费用、患者依从性（每日两次剂量）和可逆抑制作用。
