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Platelet function testing in neurovascular procedures: tool or gimmick?

Version 2 2024-09-18, 23:28
Version 1 2023-05-20, 05:40
journal contribution
posted on 2024-09-18, 23:28 authored by Nicholas CheungNicholas Cheung, MW Carr, U Ray, D McKenzie, JJ Froelich
Background: Platelet inhibitors are used to prevent thromboembolic complications related to neurovascular stenting (NVS) procedures. Despite substantial inter-individual variability of functional platelet inhibition, the value of platelet function tests (PFT) to assess inhibition remains controversial.

Objective: This study was conducted to compare differences in thromboembolic complication rates associated with NVS in platelet-inhibited patients with and without PFT. Clinical neurological outcomes were assessed by differences in the modified Rankin Scale (mRS).

Materials and Methods: One hundred seventeen consecutive patients underwent elective NVS procedures within a 7-year period. All patients received aspirin and clopidogrel 8 days before the procedure. Fifty-Two patients were treated without assessment of platelet inhibition, and 65 patients were tested for clopidogrel resistance. When clopidogrel resistance was revealed, corresponding patients were converted to ticagrelor. Changes in mRS and thromboembolic event rates were compared between the 2 cohorts.

Results: Thirty-five percent of patients from the cohort subjected to PFT tests showed inadequate platelet inhi-bition under clopidogrel and were converted to ticagrelor. Compared to the non-PFT test-cohort, neurological deficits were significantly reduced (12 vs. 0%; p = 0.009) and a lower number of thromboembolic events was found (12 vs. 3%; p > 0.05) within the test cohort.

Conclusion: PFT appears to identify patients with clopidogrel resistance prior to NVS procedures. When non-responders are converted to alternative platelet inhibitors, neurological outcomes and thromboembolic complication rates may improve. Consequently, this study provides preliminary evidence that PFT may be a useful clinical tool to enhance procedural safety and improve clinical outcomes in NVS procedures.

History

Publication title

Interventional Neurology

Volume

8

Issue

2-6

Pagination

123-134

ISSN

1664-9737

Department/School

Menzies Institute for Medical Research

Publisher

S. Karger AG

Publication status

  • Published

Place of publication

Switzerland

Rights statement

© 2019 S. Karger AG, Basel

Socio-economic Objectives

200199 Clinical health not elsewhere classified

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