Safety and Efficacy of Intensified Antiplatelet Therapy in Patients Undergoing Neuroendovascular Procedures

Introduction : The purpose of this study was to evaluate safety and efficacy of intensified antiplatelet therapy guided by VerifyNow Assay P2Y 12 reaction unit (PRU) reported values in patients undergoing neuroendovascular procedures. Methods : An observational, retrospective review was conducted at [institution blinded] from December 1, 2012, to August 31, 2014. The primary objective was to determine the prevalence of thromboembolic complications stratified by preprocedural PRU values. Secondary outcomes were assessed by investigating whether the goal PRU value of 190 or less is sufficient to reduce thromboembolic complications on the day of the procedure and 30 and 90 days post-procedure. Results : There was no statistically significant difference in the overall rate of complications in the two groups (two events in the group with preprocedural PRU values of 190 or more versus seven events in the group with preprocedural PRU values of less than 190, p =0.668). Furthermore, the rates of thromboembolic events by 90 days were not significantly different in the two groups (one event in the group with preprocedural PRU > 190 versus four events in patients with preprocedural PRU<190, p =1.000). Similarly, there was no statistically significant difference in the rate of hemorrhagic events in the two groups by 90 days postprocedure (one versus three events, p =0.558). Conclusions: The observed rate of thromboembolic and hemorrhagic complications in patients with preprocedural PRU values of less than 190 was not significantly different from the rate observed in patients with preprocedural PRU values of greater than 190. Although follow-up PRU values were not obtained prior to procedures, similar rates of thromboembolic complications in the two groups may suggest that reloading patients/administering intensified antiplatelet therapy might have prevented thromboembolic complications in patients with documented high PRU values.