比较两种预防性双重抗血小板治疗方案在血流导向/破坏装置栓塞未破裂颅内动脉瘤中的应用：一项比较氯吡格雷和替格瑞洛的匹配队列研究。
Comparison of two preventive dual antiplatelet regimens for unruptured intracranial aneurysm embolization with flow diverter/disrupter: A matched-cohort study comparing clopidogrel with ticagrelor.
机构信息
Department of neuroradiology, CHU de Reims, hôpital Maison Blanche, Université Reims-Champagne Ardenne, 51092 Reims, France; UNICAEN, Inserm, UMR-S 1237 physiopathology and imaging of neurological disorders, Cyceron, 14000 Caen, France.
Department of neuroradiology, CHU de Reims, hôpital Maison Blanche, Université Reims-Champagne Ardenne, 51092 Reims, France.
出版信息
J Neuroradiol. 2019 Nov;46(6):378-383. doi: 10.1016/j.neurad.2019.01.094. Epub 2019 Feb 5.
PURPOSE
Standard dual antiplatelet therapy (DAPT) for complex aneurysms treated with flow diversion and flow disruption is acetylsalicylic acid (ASA) plus clopidogrel. However, clopidogrel resistance frequently occurs and can lead to thromboembolic events. Ticagrelor is an alternative not requiring platelet inhibition testing. We compared two DAPT regimens (ASA with clopidogrel or ticagrelor) on morbi-mortality, safety and efficacy of unruptured aneurysm embolization with flow diverter/disrupter.
MATERIALS AND METHODS
This retrospective analysis of a 1:1 matched cohort compares patients treated with ASA + clopidogrel (March 2013-December 2015) vs. ASA + ticagrelor (January 2016-March 2017). No platelet inhibition testing was conducted. Patients matched for age (±10 years), type of treatment and aneurysm sac size ( ± 2 mm). Primary outcome measures were morbidity and mortality at 1-month; secondary outcomes were thromboembolic and hemorrhagic complications [on angiography and magnetic resonance imaging (MRI)] and groin complications. Outcomes were compared using bivariate analyses.
RESULTS
Ninety patients fulfilled inclusion criteria, of which 80 remained after matching (40 per group). There was no statistical difference in 1-month morbidity between the ticagrelor and clopidogrel groups (2.5% vs. 10%, P = 0.36) and no deaths reported. We observed no significant differences between ticagrelor and clopidogrel groups in terms of angiographic thromboembolic complications (5% vs. 12.5%, P = 0.43), territorial infarction on DWI (2.5% vs. 7.5%, P = 0.61), angiographic (0% vs. 0%, P = 1) and MRI (5% vs 5%, P = 1) hemorrhagic complications, new microbleeds (57.5% vs. 40%, P = 0.12) and groin puncture complications (2.5% vs. 0%, P = 1). At three months, there was no delayed territorial infarction or hemorrhage in either group.
CONCLUSIONS
Ticagrelor is safe and effective in replacing clopidogrel as DAPT for unruptured aneurysms.
目的
对于采用血流分流和破坏技术治疗的复杂动脉瘤，标准双联抗血小板治疗（DAPT）为阿司匹林（ASA）加氯吡格雷。然而，氯吡格雷抵抗经常发生，并可能导致血栓栓塞事件。替格瑞洛是一种不需要血小板抑制试验的替代药物。我们比较了两种 DAPT 方案（ASA 加氯吡格雷或替格瑞洛）在使用血流分流/破坏装置栓塞未破裂动脉瘤方面的死亡率、安全性和疗效。
材料和方法
这项回顾性分析比较了一组 1：1 匹配的患者，一组接受 ASA+氯吡格雷（2013 年 3 月至 2015 年 12 月）治疗，另一组接受 ASA+替格瑞洛（2016 年 1 月至 2017 年 3 月）治疗。未进行血小板抑制试验。患者按年龄（±10 岁）、治疗类型和动脉瘤囊大小（±2mm）匹配。主要观察指标为 1 个月时的发病率和死亡率；次要结局是血栓栓塞和出血并发症（血管造影和磁共振成像[MRI]）和腹股沟并发症。使用双变量分析比较结果。
结果
90 名患者符合纳入标准，其中 80 名在匹配后仍符合条件（每组 40 名）。替格瑞洛组和氯吡格雷组在 1 个月时的发病率无统计学差异（2.5%比 10%，P=0.36），无死亡报告。我们观察到替格瑞洛组和氯吡格雷组在血管造影血栓栓塞并发症方面无显著差异（5%比 12.5%，P=0.43），弥散加权成像（DWI）上的区域性梗死（2.5%比 7.5%，P=0.61），血管造影（0%比 0%，P=1）和 MRI（5%比 5%，P=1）出血并发症，新微出血（57.5%比 40%，P=0.12）和腹股沟穿刺并发症（2.5%比 0%，P=1）。在 3 个月时，两组均无迟发性区域性梗死或出血。
结论
替格瑞洛在替代氯吡格雷作为未破裂动脉瘤的 DAPT 方面是安全有效的。
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