Clopidogrel Resistance Is Associated with Thromboembolic Complications in Patients Undergoing Neurovascular Stenting
Clopidogrel Resistance Is Associated with Thromboembolic Complications in Patients Undergoing Neurovascular Stenting
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DOI：
10.3174/ajnr.a3405
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发表时间：
2013-04-01
影响因子：
3.5
通讯作者：
Chong, J.
中科院分区：
文献类型：
--
作者：
Fifi, J. T.;Brockington, C.;Chong, J.
背景和目的：抗血小板药物抵抗与冠状动脉支架置入术后血栓栓塞症的并发症有关。在接受神经血管支架置入术的患者中，它还没有得到很好的研究。本研究旨在分析抗血小板药物抵抗与神经血管支架置入并发症的关系。材料与方法：采用前瞻性数据库中所有在本机构接受治疗的患者来确定神经血管支架置入术的患者。在4.5年的时间里，所有接受神经血管支架置入术的患者都通过VerifyNow试验评估了阿司匹林和氯吡格雷的耐药性。在观察期，所有患者服用75毫克氯吡格雷和阿司匹林(A组)。在干预期(B组)，患者在氯吡格雷抵抗试验的基础上加用氯吡格雷。结果：在96例神经血管支架置入者中，5.2%的患者对阿司匹林耐药，36.5%的患者对氯吡格雷耐药。围手术期血栓并发症7例(7.3%)。在多变量Logistic回归模型中，氯吡格雷抵抗、较高的舒张压和缺乏应用他汀类药物与围手术期血栓栓塞并发症显著相关。结论：在我们的研究中，氯吡格雷抵抗与神经血管支架置入术的围术期血栓并发症的增加有关。以氯吡格雷剂量为靶点的血小板抑制试验可能会改善临床结果，需要进一步研究。
BACKGROUND AND PURPOSE: Antiplatelet drug resistance has been associated with thromboembolic complications in patients after coronary stent placement. It has not been well-studied in patients who have neurovascular stent-placement procedures. This study aimed to analyze the relationship between antiplatelet drug resistance and neurovascular stent-placement complications.MATERIALS AND METHODS: A prospective data base of all patients treated at our institution was used to identify patients with neurovascular stent-placement procedures. During a 4.5-year period, all patients undergoing neurovascular stent placement were evaluated for aspirin and clopidogrel resistance by using the VerifyNow assay. During an observational phase, all patients received 75 mg of clopidogrel and aspirin (group A). During the intervention phase (group B), patients were given additional clopidogrel on the basis of the clopidogrel resistance assay. We assessed the development of thromboembolic complications within 30 days of the procedure in patients who were resistant-versus-nonresistant to clopidogrel.RESULTS: Of 96 patients who had neurovascular stent placement, 5.2% were resistant to aspirin and 36.5% were resistant to clopidogrel. Periprocedural thromboembolic complications were seen in 7 patients (7.3%). In a multivariate logistic regression model, clopidogrel resistance, higher diastolic blood pressure, and lack of statin use were significantly associated with periprocedural thromboembolic complication. There was a nonsignificant decrease in thromboembolic complications in patients whose clopidogrel dosage was tailored to the assay.CONCLUSIONS: In our series, clopidogrel resistance was associated with increased periprocedural thromboembolic complications from neurovascular stent-placement procedures. Targeting the clopidogrel dose to platelet inhibition assays may improve clinical outcomes and requires further study.