Farrokh Salia, Owusu Kent, Lara Lucia Rivera, Nault Katharine, Hui Ferdinand, Spoelhof Brian
Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA.
Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA.
J Pharm Pract. 2021 Apr;34(2):207-215. doi: 10.1177/0897190019854868. Epub 2019 Jul 21.
Intra- and postprocedural thrombosis are major complication of aneurysmal coil embolization, stent-assisted coiling, and pipeline embolization. The common but unproven practice of dual antiplatelet therapy with aspirin and a P2Y12 inhibitor in neuro-endovascular patients is inferred from the cardiology literature without large clinical trials to support it in neuro-endovascular patients.
We conducted an electronic survey to identify practice variations surrounding the use of oral antiplatelets in patients undergoing endovascular neuro-interventional procedures across neuro-endovascular centers in the United States.
An electronic survey was distributed via the Web. Any practicing neuro-intensive care unit (ICU), neuro-interventional or stroke physician, pharmacist, physician assistant, or nurse practitioner was eligible to respond to this survey between June and October 2017.
A total of 33 responses were collected during the survey period. A response rate of 16% was calculated after taking into account all comprehensive stroke centers in the United States. Aspirin and clopidogrel was the standard-of-care antiplatelet regimen utilized in the majority of institutions (82%). Alternatively, 4 institutions used monotherapy (aspirin [n = 2], clopidogrel [n = 1], either aspirin or clopidogrel [n = 1]) and 2 institutions reported practitioner-dependent practices. Just under half of the centers reported ticagrelor as the primary alternative in clopidogrel nonresponders (48%).
Dual antiplatelet therapy with aspirin and clopidogrel appears to be standard of care in this setting based on our survey. About half of responding institutions use ticagrelor in cases where clopidogrel resistance is suspected. Large society-wide patient registries are needed to provide data for future safety and efficacy studies.
术中及术后血栓形成是动脉瘤弹簧圈栓塞、支架辅助弹簧圈栓塞和血流导向装置栓塞的主要并发症。在神经血管内介入患者中，阿司匹林和P2Y12抑制剂联合抗血小板治疗这一常见但未经证实的做法是从心脏病学文献中推断而来，尚无大型临床试验支持其在神经血管内介入患者中的应用。
我们进行了一项电子调查，以确定美国各神经血管内介入中心在接受血管内神经介入手术的患者中使用口服抗血小板药物的实践差异。
通过网络分发电子调查问卷。2017年6月至10月期间，任何从事神经重症监护病房（ICU）、神经介入或卒中治疗的医生、药剂师、医师助理或执业护士均有资格回答该调查问卷。
调查期间共收集到33份回复。考虑到美国所有综合卒中中心后，计算出回复率为16%。阿司匹林和氯吡格雷是大多数机构（82%）采用的标准抗血小板治疗方案。另外，有4家机构采用单一疗法（阿司匹林[2家]、氯吡格雷[1家]、阿司匹林或氯吡格雷[1家]），2家机构报告了依赖从业者的做法。略少于一半的中心报告称替格瑞洛是氯吡格雷无反应者的主要替代药物（48%）。
根据我们的调查，阿司匹林和氯吡格雷联合抗血小板治疗似乎是这种情况下的标准治疗方法。约一半的回复机构在怀疑氯吡格雷抵抗的情况下使用替格瑞洛。需要大型全行业患者登记系统来为未来的安全性和有效性研究提供数据。
