Hurtado-Ortiz Kevin D, Ortiz-Giraldo Andres F, D Vera-Camargo Daniela, Valenzuela-Santos Carolina, Cardenas-Sanchez Sauder A, Correa-Ruiz Paula A, Ferreira-Prada Carlos A, Galvis Melquizidel, Vargas-Pérez Oliverio, Serrano-Gómez Sergio, Reyes Adriana, Mantilla-Garcia Daniel E
Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia; Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia.
Interventional Radiology Department, Fundación Oftalmológica de Santander - Clínica Ardila Lülle, Floridablanca, Colombia.
World Neurosurg. 2023 Sep;177:e408-e414. doi: 10.1016/j.wneu.2023.06.063. Epub 2023 Jun 22.
Thromboembolic events are critical complications in neuroendovascular procedures, and dual antiplatelet therapy (DAPT) can reduce them. The effects of using aspirin and clopidogrel in DAPT are well characterized, but use of aspirin and ticagrelor has been less studied.
This retrospective cohort study, conducted between April 1, 2015, and December 30, 2020, included patients with endovascular treatment with flow-diverting and non-flow-diverting stents for unruptured cerebral aneurysms who received DAPT with aspirin and clopidogrel or with aspirin and ticagrelor.
Of 148 patients with unruptured intracranial aneurysms with flow-diverting and non-flow-diverting stents started on DAPT with aspirin (100 mg/day) and clopidogrel (75 mg/day), 24 had a poor response to clopidogrel according to the VerifyNow test and had DAPT changed to aspirin (100 mg/day) and ticagrelor (90 mg every 12 hours). One thrombotic complication (0.81%) and 1 bleeding complication (0.81%) occurred in patients receiving DAPT with clopidogrel and aspirin during the procedure. These complications did not occur (0.00%) in patients receiving DAPT with ticagrelor and aspirin. At the 6-month follow-up, 4 patients (3.15%) in the clopidogrel group presented with thrombotic complications, whereas no patients (0.00%) in the ticagrelor group experienced this complication. At 6-month follow-up, 4 patients (3.23%) in the clopidogrel group presented with hemorrhagic complications, whereas only 1 patient (4.17%) in the ticagrelor group experienced this complication.
Our study showed that DAPT with ticagrelor (90 mg every 12 hours) and aspirin (100 mg/day) is a safe and effective alternative to DAPT with clopidogrel (75 mg/day) and aspirin (100 mg/day) for patients with an inadequate response to clopidogrel.
血栓栓塞事件是神经血管内介入手术中的关键并发症，双联抗血小板治疗（DAPT）可降低此类事件的发生。阿司匹林和氯吡格雷在DAPT中的作用已得到充分研究，但阿司匹林和替格瑞洛的应用研究较少。
这项回顾性队列研究于2015年4月1日至2020年12月30日进行，纳入了因未破裂脑动脉瘤接受分流和非分流支架血管内治疗且接受阿司匹林和氯吡格雷或阿司匹林和替格瑞洛DAPT的患者。
148例因未破裂颅内动脉瘤接受分流和非分流支架治疗并开始使用阿司匹林（100mg/天）和氯吡格雷（75mg/天）进行DAPT的患者中，根据VerifyNow检测，24例对氯吡格雷反应不佳，DAPT改为阿司匹林（100mg/天）和替格瑞洛（每12小时90mg）。在手术过程中，接受氯吡格雷和阿司匹林DAPT的患者发生1例血栓并发症（0.81%）和1例出血并发症（0.81%）。接受替格瑞洛和阿司匹林DAPT的患者未发生这些并发症（0.00%）。在6个月的随访中，氯吡格雷组有4例患者（3.15%）出现血栓并发症，而替格瑞洛组无患者（0.00%）出现该并发症。在6个月的随访中，氯吡格雷组有4例患者（3.23%）出现出血并发症，而替格瑞洛组仅有1例患者（4.17%）出现该并发症。
我们的研究表明，对于氯吡格雷反应不足的患者，替格瑞洛（每12小时90mg）和阿司匹林（100mg/天）的DAPT是氯吡格雷（75mg/天）和阿司匹林（100mg/天）DAPT的一种安全有效的替代方案。
