在使用密网支架栓塞装置治疗的脑动脉瘤患者中，末次记录的P2Y12反应单位值与治疗后长达6个月内发生的血栓栓塞和出血并发症密切相关。
Last-recorded P2Y12 reaction units value is strongly associated with thromboembolic and hemorrhagic complications occurring up to 6 months after treatment in patients with cerebral aneurysms treated with the pipeline embolization device.
作者信息
Delgado Almandoz J E, Crandall B M, Scholz J M, Fease J L, Anderson R E, Kadkhodayan Y, Tubman D E
机构信息
Division of Interventional Neuroradiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
出版信息
AJNR Am J Neuroradiol. 2014 Jan;35(1):128-35. doi: 10.3174/ajnr.A3621. Epub 2013 Jul 4.
BACKGROUND AND PURPOSE
A recent study identified a preprocedural P2Y12 reaction units value of <60 or >240 as a strong independent predictor of perioperative thromboembolic and hemorrhagic complications after treatment of cerebral aneurysms with the Pipeline Embolization Device. This study aimed to determine whether a last-recorded P2Y12 reaction units value of <60 or >240 predicts thromboembolic and hemorrhagic complications up to 6 months after treatment of cerebral aneurysms with the Pipeline Embolization Device in the same patient cohort.
MATERIALS AND METHODS
We recorded patient and aneurysm characteristics, P2Y12 receptor antagonist administered, P2Y12 reaction units value with VerifyNow, procedural variables, and thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures at our institution during an 8-month period. Complications causing a permanent disabling neurologic deficit or death were considered major. Multivariate regression analysis was performed to identify independent predictors of thromboembolic and hemorrhagic complications.
RESULTS
Forty-four patients underwent 48 Pipeline Embolization Device procedures at our institution during the study period. There were 11 thromboembolic and hemorrhagic complications up to 6 months after treatment in our cohort (22.9%), 5 of which were major (10.4%). A last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all (P = .002) and major (P = .03) thromboembolic and hemorrhagic complications in our cohort. Most patients (71%) required, on average, 2 adjustments to the dose or type of P2Y12 receptor antagonist to remain within the 60-240 target P2Y12 reaction units range.
CONCLUSIONS
In our cohort, a last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all and major thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures.
背景与目的
最近一项研究确定，在使用Pipeline栓塞装置治疗脑动脉瘤后，术前P2Y12反应单位值<60或>240是围手术期血栓栓塞和出血并发症的强有力独立预测指标。本研究旨在确定在同一患者队列中，最后记录的P2Y12反应单位值<60或>240是否能预测使用Pipeline栓塞装置治疗脑动脉瘤后长达6个月的血栓栓塞和出血并发症。
材料与方法
我们记录了在8个月期间，于本院接受Pipeline栓塞装置手术患者的患者及动脉瘤特征、使用的P2Y12受体拮抗剂、VerifyNow检测的P2Y12反应单位值、手术变量以及术后长达6个月的血栓栓塞和出血并发症情况。导致永久性致残神经功能缺损或死亡的并发症被视为严重并发症。进行多因素回归分析以确定血栓栓塞和出血并发症的独立预测指标。
结果
在研究期间，本院有44例患者接受了48次Pipeline栓塞装置手术。在我们的队列中，治疗后长达6个月有11例血栓栓塞和出血并发症（22.9%），其中5例为严重并发症（10.4%）。最后记录的P2Y12反应单位值<60或>240是我们队列中所有（P = .002）和严重（P = .03）血栓栓塞和出血并发症的唯一独立预测指标。大多数患者（71%）平均需要对P2Y12受体拮抗剂的剂量或类型进行2次调整，以使其保持在60 - 240的目标P2Y12反应单位范围内。
结论
在我们的队列中，最后记录的P2Y12反应单位值<60或>240是使用Pipeline栓塞装置手术后长达6个月所有及严重血栓栓塞和出血并发症的唯一独立预测指标。
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