Purpose

The aim of this study was to determine whether half-dose loading (30 mg) of prasugrel is sufficient to achieve adequate platelet inhibition, and whether such a loading dose of prasugrel together with aspirin followed by a 10 mg/day prasugrel maintenance, could serve as a first-line antiplatelet strategy for patients undergoing flow-diverting stent (FDS) implantation.

Methods

Data from a group of consecutive patients treated for intracranial aneurysm with FDS were retrospectively collected. Platelet P2Y12 receptor responsiveness was assessed by a rapid platelet function test just prior to the procedure. All ischemic and hemorrhagic complications as well as morbidity and mortality rates were documented.

Results

A total of 138 patients with 153 aneurysms (32 were symptomatic and 121 were incidental) underwent FDS treatment in a total of 147 loading sessions. Adequate platelet inhibition was obtained in 136/138 (98.5%) patients and 145/147 (98.6%) loading sessions. Overall, there was one case of (hemorrhagic) mortality (0.7%), one of (ischemic) morbidity (0.7%), one of symptomatic (hemorrhagic) clinical complications without permanent deficits (0.7%), and six transient ischemic attacks (4.1%). The 6‑month control angiography, available for all patients, revealed a 95.4% aneurysm occlusion rate.

Conclusion

Half-dose (30 mg) prasugrel loading results in effective platelet P2Y12 receptor inhibition in more than 98% of patients. Dual antiaggregant loading with half dose prasugrel followed by prasugrel maintenance as a first-line therapy appears to be feasible in patients treated with FDS implantation for intracranial aneurysm.

中文翻译：

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在分流支架植入中对半剂量普拉格雷的凝集反应。

目的

这项研究的目的是确定普拉格雷的半剂量负荷量（30 mg）是否足以实现足够的血小板抑制作用，普拉格雷与阿司匹林并用10毫克/天的普拉格雷维持剂量是否能有效作为接受分流支架（FDS）植入的患者的一线抗血小板策略。

方法

回顾性收集了一组接受FDS治疗颅内动脉瘤的连续患者的数据。在手术前立即通过快速血小板功能测试评估血小板P2Y12受体反应性。记录所有缺血性和出血性并发症以及发病率和死亡率。

结果

总共147次负荷治疗，总共138例动脉瘤153例（有症状的32例，偶发的121例）接受了FDS治疗。136/138（98.5％）患者和145/147（98.6％）负荷患者获得了足够的血小板抑制。总体而言，一例（出血性）死亡率（0.7％），一例（缺血性）发病率（0.7％），一例无永久性缺陷的有症状（出血性）临床并发症（0.7％）和六例短暂性脑缺血发作（4.1） ％）。所有患者均可进行为期6个月的对照血管造影，显示95.4％的动脉瘤闭塞率。

结论

半剂量（30 mg）普拉格雷剂量可在98％以上的患者中有效抑制血小板P2Y12受体。对于颅内动脉瘤行FDS植入的患者，以半剂量普拉格雷进行双重抗凝集治疗，然后采用普拉格雷维持作为一线治疗似乎是可行的。