BACKGROUND Dual antiplatelet therapy (DAPT) is standard care for intracranial stenting to prevent thrombotic complications. Clopidogrel resistance has resulted in patients receiving newer P2Y12 inhibitors like Prasugrel, which may reduce thrombotic complications but could increase haemorrhagic complications. This study, utilising platelet reactivity testing, compared thrombotic and haemorrhagic complications associated with Clopidogrel or 20 mg Prasugrel loading in patients treated with flow diverters (FD) for intracranial aneurysms. METHODS We retrospectively analysed prospectively collected data from 225 consecutive FD procedures. All patients received aspirin. 147 cases received Clopidogrel and 82 received Prasugrel. All patients had VerifyNow testing before the procedure. RESULTS P2Y12 non-responders were significantly more likely to have thrombotic complications than responders and hyper-responders (7% vs. 2%, p = 0.01). Low-dose Prasugrel resulted in a significantly lower rate of non-responders when compared with Clopidogrel (7% vs. 25%, p < 0.01). We found no statistically significant difference in rates of haemorrhage between the Clopidogrel and Prasugrel groups (2.4% vs. 3.9%, p = 0.47). There were 12 complications (≤7 days) in the Clopidogrel group versus 6 in the Prasugrel group (9% vs. 7.8%, respectively, p = 0.91) and a non-significant reduction in thrombotic complications in the Prasugrel group (5.2% vs. 3.9%, p = 0.88). No significant difference was shown in long-term complications between the groups (p = 0.33). CONCLUSION These results support the use of platelet reactivity testing and the safety of low-dose Prasugrel for FD treatment of intracranial aneurysms.

中文翻译：

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使用阿司匹林和低剂量普拉格雷的双重抗血小板治疗以及血小板反应性测试在颅内动脉瘤的分流器治疗中的安全性。

背景双重抗血小板治疗（DAPT）是颅内支架置入术的标准护理，以预防血栓并发症。氯吡格雷耐药导致患者接受普拉格雷等新型 P2Y12 抑制剂，这可能会减少血栓并发症，但可能会增加出血并发症。这项研究利用血小板反应性测试，比较了接受分流器 (FD) 治疗颅内动脉瘤的患者与氯吡格雷或 20 mg 普拉格雷负荷相关的血栓和出血并发症。方法 我们回顾性分析了从 225 例连续 FD 手术中前瞻性收集的数据。所有患者均接受阿司匹林治疗。147 例接受氯吡格雷治疗，82 例接受普拉格雷治疗。所有患者在手术前均进行了VerifyNow 测试。结果 P2Y12 无反应者比反应者和高反应者更容易出现血栓并发症（7% vs. 2%，p = 0.01）。与氯吡格雷相比，低剂量普拉格雷的无反应率显着降低（7% vs. 25%，p < 0.01）。我们发现氯吡格雷组和普拉格雷组之间的出血率没有统计学上的显着差异（2.4% vs. 3.9%，p = 0.47）。氯吡格雷组有 12 例并发症（≤7 天），而普拉格雷组有 6 例（分别为 9% 和 7.8%，p = 0.91），普拉格雷组的血栓并发症没有显着减少（分别为 5.2% 和 7.8%）。 .3.9%，p = 0.88）。各组之间的长期并发症没有显着差异（p = 0.33）。结论 这些结果支持血小板反应性测试的使用以及低剂量普拉格雷用于 FD 颅内动脉瘤治疗的安全性。