Department of Neurosurgery, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
Department of Critical Care Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
PLoS One. 2023 Jun 23;18(6):e0287190. doi: 10.1371/journal.pone.0287190. eCollection 2023.
Prophylactic prasugrel for endovascular treatment of intracranial aneurysms has been introduced and increased, but HTPR (high on-treatment platelet reactivity) or LTPR (low on-treatment platelet reactivity) of prasugrel is not uncommon in clinical circumstances. To investigate the predisposing factors of HTPR and LTPR on prasugrel premedication in the neurointerventional field and to determine its clinical implications.
Between February 2016 and December 2020, 191 patients treated with coil embolization using prophylactic prasugrel in 234 intracranial aneurysms were the final candidates for this study. Patient and aneurysm characteristics, clinical status, and laboratory study values were carefully reviewed retrospectively. We performed risk factor analyses for HTPR and LTPR on prasugrel.
Ultimately, 20 patients (10.5%) had HTPR, and 74 patients (38.7%) were categorized as having LTPR. In multivariable analyses, the factors related to HTPR were BMI (adjusted OR 1.21, 95% CI 1.04-1.41, p = 0.01), history of antithrombotics (adjusted OR 3.79, 95% CI 1.39-10.34, p = 0.01), and hematocrit (adjusted OR 0.91, 95% CI 0.84-0.99, p = 0.03). Low BMI was the only risk factor for LTPR (adjusted OR 0.84, 95% CI 0.76-0.94, p = 0.001).
In the neurointerventional field, high BMI and prior use of antithrombotic agents were related to HTPR, and low BMI was associated with LTPR on prophylactic prasugrel. High hematocrit levels decreased the risk of HTPR. When preparing endovascular treatment for intracranial aneurysms, attention to patients with these clinical features is required to address the possibility of ischemic or bleeding complications.
颅内动脉瘤血管内治疗中已预防性应用普拉格雷，但临床中常出现普拉格雷高反应性（HTPR）或低反应性（LTPR）。本研究旨在探讨神经介入领域中普拉格雷预处理时发生 HTPR 和 LTPR 的相关危险因素，并明确其临床意义。
回顾性分析 2016 年 2 月至 2020 年 12 月 234 个颅内动脉瘤行线圈栓塞治疗中接受预防性普拉格雷治疗的 191 例患者的资料。仔细分析患者和动脉瘤特征、临床状态及实验室研究值。对 HTPR 和 LTPR 的普拉格雷危险因素进行分析。
最终 20 例（10.5%）患者出现 HTPR，74 例（38.7%）患者为 LTPR。多变量分析显示，HTPR 的相关因素包括 BMI（调整后 OR 1.21，95%CI 1.04-1.41，p=0.01）、抗栓药物史（调整后 OR 3.79，95%CI 1.39-10.34，p=0.01）和血细胞比容（调整后 OR 0.91，95%CI 0.84-0.99，p=0.03）。低 BMI 是 LTPR 的唯一危险因素（调整后 OR 0.84，95%CI 0.76-0.94，p=0.001）。
在神经介入领域，高 BMI 和既往应用抗栓药物与 HTPR 相关，低 BMI 与预防性普拉格雷的 LTPR 相关。高血细胞比容降低 HTPR 的风险。在为颅内动脉瘤的血管内治疗做准备时，需要注意这些临床特征，以处理可能发生的缺血或出血并发症。
