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Monitoring of Clopidogrel-Related Platelet Inhibition: Correlation of Nonresponse with Clinical Outcome in Supra-Aortic Stenting

Monitoring of Clopidogrel-Related Platelet Inhibition: Correlation of Nonresponse with Clinical... This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A0917v1 29/4/786 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Müller-Schunk, S. Articles by Mayer, T.E. Search for Related Content PubMed PubMed Citation Articles by Müller-Schunk, S. Articles by Mayer, T.E. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:786-791, April 2008 © 2008 American Society of Neuroradiology INTERVENTIONAL Monitoring of Clopidogrel-Related Platelet Inhibition: Correlation of Nonresponse with Clinical Outcome in Supra-Aortic Stenting S. Müller-Schunk a , J. Linn a , N. Peters b , M. Spannagl c , M. Deisenberg d , H. Brückmann a and T.E. Mayer a a Department of Neuroradiology, Ludwig Maximilians University, Munich, Germany b Department of Neurology, Ludwig Maximilians University, Munich, Germany c Department of Hemostaseology, Ludwig Maximilians University, Munich, Germany d Department of Anesthesiology, Ludwig Maximilians University, Munich, Germany Please address correspondence to Stefanie Müller-Schunk, Department of Neuroradiology, Klinikum Grosshadern, Ludwig Maximilians University Munich, Marchioninistr 15, 81377 Muenchen, Germany; e-mail: smueller@med.uni-muenchen.de BACKGROUND AND PURPOSE: Clopidogrel and aspirin are antiplatelet medications used in patients intended for endovascular stent placement. Although various studies have investigated individual responsiveness to clopidogrel in patients undergoing coronary interventions, there are no studies regarding patients undergoing stent placement of supra-aortic arteries supplying the brain. We analyzed platelet function in a near-patient setting to determine the effects of antiplatelet treatment in neurologic patients and correlated the results with clinical outcome after stent placement. MATERIALS AND METHODS: The platelet function of 50 consecutive patients scheduled for neurointerventional stent placement procedures was assessed by using point-of-care testing. All of the patients had symptomatic arteriosclerotic lesions. Clopidogrel effects were tested by impedance aggregometry. Fifty healthy blood donors without clopidogrel medication served as the control group. RESULTS: Reference values for responders and nonresponders were established from the results of the healthy control group. Fourteen (28%) of 50 neurologic patients were stratified as clopidogrel nonresponders. Adverse events were registered in 5 (10%) of 50 patients, 1 of them with a permanent neurologic deficit (1 of 50 2%). All 5 of the patients with adverse events were nonresponders. There was a statistically significant correlation between adverse events and clopidogrel nonresponse (Fisher exact test, P = .001). CONCLUSION: A significant rate of clopidogrel nonresponders could be identified in the treated patients. Our data strongly suggest a correlation of insufficient clopidogrel-related platelet inhibition with an increased risk of thromboembolic events in supra-aortic stent placement. This article has been cited by other articles: M. Piotin, R. Blanc, L. Spelle, C. Mounayer, R. Piantino, P. J. Schmidt, and J. Moret Stent-Assisted Coiling of Intracranial Aneurysms: Clinical and Angiographic Results in 216 Consecutive Aneurysms Stroke, January 1, 2010; 41(1): 110 - 115. Abstract Full Text PDF C. Jambor, C. F. Weber, K. Gerhardt, W. Dietrich, M. Spannagl, B. Heindl, and B. Zwissler Whole Blood Multiple Electrode Aggregometry Is a Reliable Point-of-Care Test of Aspirin-Induced Platelet Dysfunction Anesth. Analg., July 1, 2009; 109(1): 25 - 31. Abstract Full Text PDF A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. Abstract Full Text PDF M. Spannagl and C. Jambor Baseline Platelet Reactivity as Determined by TRAP-6 Induced Aggregation in Whole Blood Is Related to the Rate of Non-Responsiveness to Clopidogrel Blood (ASH Annual Meeting Abstracts), November 16, 2008; 112(11): 5362 - 5362. Abstract Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Monitoring of Clopidogrel-Related Platelet Inhibition: Correlation of Nonresponse with Clinical Outcome in Supra-Aortic Stenting

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A0917
Publisher site
See Article on Publisher Site

Abstract

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A0917v1 29/4/786 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Müller-Schunk, S. Articles by Mayer, T.E. Search for Related Content PubMed PubMed Citation Articles by Müller-Schunk, S. Articles by Mayer, T.E. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 29:786-791, April 2008 © 2008 American Society of Neuroradiology INTERVENTIONAL Monitoring of Clopidogrel-Related Platelet Inhibition: Correlation of Nonresponse with Clinical Outcome in Supra-Aortic Stenting S. Müller-Schunk a , J. Linn a , N. Peters b , M. Spannagl c , M. Deisenberg d , H. Brückmann a and T.E. Mayer a a Department of Neuroradiology, Ludwig Maximilians University, Munich, Germany b Department of Neurology, Ludwig Maximilians University, Munich, Germany c Department of Hemostaseology, Ludwig Maximilians University, Munich, Germany d Department of Anesthesiology, Ludwig Maximilians University, Munich, Germany Please address correspondence to Stefanie Müller-Schunk, Department of Neuroradiology, Klinikum Grosshadern, Ludwig Maximilians University Munich, Marchioninistr 15, 81377 Muenchen, Germany; e-mail: smueller@med.uni-muenchen.de BACKGROUND AND PURPOSE: Clopidogrel and aspirin are antiplatelet medications used in patients intended for endovascular stent placement. Although various studies have investigated individual responsiveness to clopidogrel in patients undergoing coronary interventions, there are no studies regarding patients undergoing stent placement of supra-aortic arteries supplying the brain. We analyzed platelet function in a near-patient setting to determine the effects of antiplatelet treatment in neurologic patients and correlated the results with clinical outcome after stent placement. MATERIALS AND METHODS: The platelet function of 50 consecutive patients scheduled for neurointerventional stent placement procedures was assessed by using point-of-care testing. All of the patients had symptomatic arteriosclerotic lesions. Clopidogrel effects were tested by impedance aggregometry. Fifty healthy blood donors without clopidogrel medication served as the control group. RESULTS: Reference values for responders and nonresponders were established from the results of the healthy control group. Fourteen (28%) of 50 neurologic patients were stratified as clopidogrel nonresponders. Adverse events were registered in 5 (10%) of 50 patients, 1 of them with a permanent neurologic deficit (1 of 50 2%). All 5 of the patients with adverse events were nonresponders. There was a statistically significant correlation between adverse events and clopidogrel nonresponse (Fisher exact test, P = .001). CONCLUSION: A significant rate of clopidogrel nonresponders could be identified in the treated patients. Our data strongly suggest a correlation of insufficient clopidogrel-related platelet inhibition with an increased risk of thromboembolic events in supra-aortic stent placement. This article has been cited by other articles: M. Piotin, R. Blanc, L. Spelle, C. Mounayer, R. Piantino, P. J. Schmidt, and J. Moret Stent-Assisted Coiling of Intracranial Aneurysms: Clinical and Angiographic Results in 216 Consecutive Aneurysms Stroke, January 1, 2010; 41(1): 110 - 115. Abstract Full Text PDF C. Jambor, C. F. Weber, K. Gerhardt, W. Dietrich, M. Spannagl, B. Heindl, and B. Zwissler Whole Blood Multiple Electrode Aggregometry Is a Reliable Point-of-Care Test of Aspirin-Induced Platelet Dysfunction Anesth. Analg., July 1, 2009; 109(1): 25 - 31. Abstract Full Text PDF A. K. Wakhloo, M. J. Deleo III, and M. M. Brown Advances in Interventional Neuroradiology Stroke, May 1, 2009; 40(5): e305 - e312. Abstract Full Text PDF M. Spannagl and C. Jambor Baseline Platelet Reactivity as Determined by TRAP-6 Induced Aggregation in Whole Blood Is Related to the Rate of Non-Responsiveness to Clopidogrel Blood (ASH Annual Meeting Abstracts), November 16, 2008; 112(11): 5362 - 5362. Abstract Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Apr 1, 2008

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