Abstract Details

Title Clopidogrel versus Prasugrel towards Prevention of Stent Thrombosis of Intracranial Aneurysm – A metanalysis and literature review

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P15 - Poster Session 15 (12:00 PM-1:00 PM)

Poster/Presentation
Number 13-012

Objective The purpose of this met-analysis is to identify the efficacy of different antiplatelet agents to prevent the thrombosis after intra-cranial aneurysm repair.

Background The coiling with the placement of an intracranial stent is associated with increased thromboembolic complications. The dual antiplatelet therapy (DAPT) including aspirin and clopidogrel are used to prevent thrombotic complication after coiling and stent placement for aneurysm securing. The prasugrel and clopidogrel belong to the same pharmacological class of P2Y12 receptor blockers.

Design/Methods We searched PubMed, Cochrane, and EMBASE databases for studies using DAPT with aspirin plus clopidogrel compared to aspirin plus prasugrel to prevent stent thrombosis with pipeline embolization devices. In most studies, patients either allergic or having less than 30-40% platelet inhibition to a daily 75-mg dose of clopidogrel received 10 mg of prasugrel daily after 60 mg of the loading dose. Primary outcomes of thromboembolic or intracerebral bleeding and the secondary outcome of mortality were assessed.

Results Total of 1152 patients in 7 clinical studies were analyzed. All patients receiving DAPT with either clopidogrel or prasugrel had a modified Rankin scale (mRS) score <2. Patients treated with prasugrel had a wide-based neck (p<0.05] and had more flow diversion stents in place [p=0.021]. There was no difference in post occlusion aneurysm rate in either groups [p<0.032]. There were no thrombotic or hemorrhagic complications between either DAPT with prasugrel or clopidogrel groups [HR 0.67; 95% CI 0.62 to 0.72; p<0.001]. However, prasugrel 10 mg maintenance daily dose when compared to 3.75 mg daily dose was associated with more hemorrhagic events after coiling with stenting [HR 1.57; 95% CI 1.24 to 1.74; p=0.011]. There was significant heterogeneity among included studies (pooled HR, 1.02; 95% confidence interval, 0.55-1.67; Q=23.57, P for heterogeneity <0.001).

Conclusions The use of prasugrel in clopidogrel non-responders is clinically effective in the prevention of intracranial stent thromboembolic complications.

Authors/Disclosures
PRESENTER	No disclosure on file
Salman Assad, MD, MBBS	Dr. Assad has nothing to disclose.
	No disclosure on file
Justin M. Nolte, MD	Dr. Nolte has nothing to disclose.
Samrina Hanif, MD	Dr. Hanif has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for LivaNova .

�鶹��ýӳ��

�鶹��ýӳ��

Abstract Details