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Effect of premedication method and drug resistance of antiplatelet agent on periprocedural thromboembolic events during coil embolization of an unruptured intracranial aneurysm

Title
Effect of premedication method and drug resistance of antiplatelet agent on periprocedural thromboembolic events during coil embolization of an unruptured intracranial aneurysm
Authors
Se Hwan Park;Yong Bae Kim;Seung Kon Huh
Issue Date
2012
Journal Title
Journal of Cerebrovascular and Endovascular Neurosurgery
ISSN
2234-8565
Citation
Journal of Cerebrovascular and Endovascular Neurosurgery, Vol.14(3) : 148~156, 2012
Abstract
OBJECTIVE: A retrospective review of premedication method and drug resistance of aspirin and clopidogrel in association with thromboembolic events during and after coil embolization of an unruptured intracranial aneurysm was conducted. METHODS: Our premedication policy for coil embolization of an unruptured intracranial aneurysm has changed from administration of the loading dose before the procedure (i.e. loading group) to repeated administration of the maintenance dose for several days (i.e. preparation group). The loading group (27 patients with 29 aneurysms) and the preparation group (30 patients with 35 aneurysms) were compared for identification of the effect of premedication method on periprocedural thromboembolic events. The results of drug response assays of the preparation group were analyzed with respect to periprocedural thromboembolic events. RESULTS: No statistically significant difference in incidence of thromboembolic events was observed between the loading group and the preparation group. Analysis of the results of the drug response assay showed high prevalence (56.7%, 73.3%) of clopidogrel resistance and relatively low prevalence (6.7%) of aspirin resistance. Patients who had thromboembolic events tended to have lower responsiveness to both aspirin and clopidogrel than patients without it. CONCLUSION: The method of antiplatelet premedication does not affect the rate of periprocedural thromboembolic events in coil embolization for treatment of an unruptured intracranial aneurysm. Nevertheless, considering the high prevalence of drug resistance, it is reasonable to premedicate antiplatelet agents in the preparation method for the drug response assay. Use of a higher dose of aspirin and clopidogrel or addition of an alternative drug (cilostazol or triflusal) can be applied against antiplatelet agent resistance. However, because the hemorrhagic risk associated with this supplementary use of antiplatelet agent has not been well-documented, the hemorrhagic risk and the preventive benefit must be weighed.
URI

http://ir.ymlib.yonsei.ac.kr/handle/22282913/90670
DOI
10.7461/jcen.2012.14.3.148
Appears in Collections:
1. 연구논문 > 1. College of Medicine > Dept. of Neurosurgery
Yonsei Authors
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