Safety of dual antiplatelet therapy using aspirin and low-dose Prasugrel with platelet reactivity testing in flow diverter treatment of intracranial aneurysms

• Published in: Interventional neuroradiology 2023-11, p.15910199231217142-15910199231217142
• Main Authors: Flynn, Liam M, Mohamed, Ezaz, Dobbs, Nicholas, Nania, Alberto, Du Plessis, Johannes, Keston, Peter M, Downer, Jonny J
• Format: Article
• Language: English
• ISSN: 1591-0199; 2385-2011
• DOI: 10.1177/15910199231217142

BACKGROUNDDual 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.METHODSWe 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.RESULTSP2Y12 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