Khanafer Ali, Cimpoca Alexandru, Bhogal Paul, Babiy-Pachomow Oksana, Kurucz Peter, Ganslandt Oliver, Henkes Hans
Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
J Neuroradiol. 2023 Feb;50(1):65-73. doi: 10.1016/j.neurad.2022.03.004. Epub 2022 Mar 17.
Prasugrel (Pra) is a third-generation thienopyridine that inhibits platelet aggregation via irreversible blockade of P2Y12 receptors. While several published studies have examined the use of Pra and acetylsalicylic acid (ASA) in coronary and neurovascular stenting procedures, there is only anecdotal evidence regarding the use of Pra as single antiplatelet therapy (SAPT) in open surgical procedures. This topic has become important because previous studies have revealed that neurovascular devices with antithrombotic coatings can be implanted using non-invasive procedures in patients maintained on Pra SAPT.
Patients who underwent open surgery under Pra SAPT between March 2020 and February 2022 were evaluated retrospectively. Adequate platelet inhibition both before and after the procedures was verified in all patients using Multiplate (Roche Diagnostics) and VerifyNow (Accriva) tests. Intraoperative and postoperative hemorrhagic events were recorded based on reviews of the procedure reports and interviews with the surgeons.
The study enrolled 21 patients who underwent 23 open surgical procedures while maintained on Pra SAPT. The procedures included one extirpation of a brain arteriovenous malformation, seven extra-intracranial bypass surgeries, four ventriculoperitoneal shunts, one eye enucleation for an intractable orbital infection, two gastrostomies, one bone flap reinsertion after craniectomy, one decompressive craniectomy, one case requiring cranial surgical wound care, one colporrhaphy, one transurethral resection of urinary bladder cancer, two tumor oophorectomy/hysterectomy procedures, and one aneurysm clipping. None of the 23 procedures resulted in excessive intraoperative or postoperative hemorrhage.
In a small retrospective series of patients who required antiplatelet therapy for neurovascular indications, Pra SAPT resulted in no significant increase in the incidence of perioperative and postoperative hemorrhagic complications.
普拉格雷（Pra）是一种第三代噻吩并吡啶类药物，通过不可逆地阻断P2Y12受体来抑制血小板聚集。虽然已有多项发表的研究探讨了普拉格雷与阿司匹林（ASA）在冠状动脉和神经血管支架置入术中的应用，但关于普拉格雷在开放性外科手术中作为单一抗血小板治疗（SAPT）的应用仅有轶事性证据。由于先前的研究表明，对于接受普拉格雷SAPT治疗的患者，可以使用非侵入性手术植入具有抗血栓涂层的神经血管装置，因此这个话题变得很重要。
对2020年3月至2022年2月期间在普拉格雷SAPT治疗下接受开放性手术的患者进行回顾性评估。使用Multiplate（罗氏诊断）和VerifyNow（Accriva）检测在所有患者中验证手术前后的血小板抑制是否充分。根据手术报告回顾和与外科医生的访谈记录术中及术后出血事件。
该研究纳入了21例患者，他们在接受普拉格雷SAPT治疗期间接受了23例开放性外科手术。手术包括1例脑动静脉畸形切除术、7例颅外-颅内搭桥手术、4例脑室-腹腔分流术、1例因顽固性眼眶感染行眼球摘除术、2例胃造瘘术、1例颅骨切除术后骨瓣复位术、1例减压性颅骨切除术、1例需要颅骨手术伤口护理的病例、1例阴道修补术、1例经尿道膀胱癌切除术、2例肿瘤性卵巢切除术/子宫切除术以及1例动脉瘤夹闭术。23例手术均未导致术中或术后过度出血。
在一个小样本回顾性系列研究中，对于因神经血管适应证需要抗血小板治疗的患者，普拉格雷SAPT并未导致围手术期和术后出血并发症的发生率显著增加。
