Xia Pengfei, Huang Yimin, Chen Gang
Department of Neurosurgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Brain Sci. 2022 Aug 14;12(8):1077. doi: 10.3390/brainsci12081077.
Endovascular interventional is an important treatment method for intracranial aneurysms. However, due to the risk of intracranial thrombosis, prophylactic use of antiplatelet drugs is generally required. Clinically, the most commonly used drugs are aspirin and clopidogrel; although the latter can significantly reduce the incidence of thromboembolic complications, there are still some patients with clopidogrel resistance who have ischemic adverse events during antiplatelet therapy. In this study, cohort studies of PubMed, Embase and Cochrane Library Databases were retrieved to compare the efficacy and safety of ticagrelor and clopidogrel in endovascular interventional treatment of intracranial aneurysms. A total of 10 cohort studies involving 1377 patients were included in this study. All patients had intracranial aneurysms and underwent endovascular intervention. Platelet function was measured in four of the studies and switched the patients with clopidogrel resistance to ticagrelor, while the remaining six studies did not test platelet function, but were also treated with ticagrelor or clopidogrel. The results of the study showed that ticagrelor, like clopidogrel, can effectively control thrombotic complications in endovascular interventional patients, and also control the occurrence of ischemic complications in clopidogrel-resistant patients. Ticagrelor, as a novel platelet aggregation inhibitor that can reversibly bind to P2Y12 receptor, can effectively control thromboembolic complications without increasing hemorrhagic complications, and is also effective in patients with clopidogrel resistance.
血管内介入治疗是颅内动脉瘤的重要治疗方法。然而，由于存在颅内血栓形成的风险，通常需要预防性使用抗血小板药物。临床上，最常用的药物是阿司匹林和氯吡格雷；尽管后者可显著降低血栓栓塞并发症的发生率，但仍有一些氯吡格雷抵抗患者在抗血小板治疗期间发生缺血性不良事件。在本研究中，检索了PubMed、Embase和Cochrane图书馆数据库的队列研究，以比较替格瑞洛和氯吡格雷在颅内动脉瘤血管内介入治疗中的疗效和安全性。本研究共纳入10项涉及1377例患者的队列研究。所有患者均患有颅内动脉瘤并接受了血管内介入治疗。其中4项研究测量了血小板功能，并将氯吡格雷抵抗患者换用替格瑞洛，而其余6项研究未检测血小板功能，但也采用替格瑞洛或氯吡格雷进行治疗。研究结果表明，替格瑞洛与氯吡格雷一样，可有效控制血管内介入治疗患者的血栓形成并发症，还可控制氯吡格雷抵抗患者缺血性并发症的发生。替格瑞洛作为一种新型血小板聚集抑制剂，可与P2Y12受体可逆性结合，能有效控制血栓栓塞并发症，且不增加出血并发症，对氯吡格雷抵抗患者也有效。
