J Korean Neurosurg Soc.  2020 Sep;63(5):539-549. 10.3340/jkns.2019.0082.

The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysis

• Kim HJ
• Oh JS
• Park SQ
• Yoon SM
• Ahn HS
• Kim BT

• KMID: 2506017
• DOI: http://doi.org/10.3340/jkns.2019.0082

Abstract

The efficacy of P2Y12 reaction unit (PRU) of VerifyNow still remains as a controversial issue in neurointervention. So we investigated the usefulness of PRU of VerifyNow to predict the peri-procedural thromboembolic events (TE) and hemorrhagic events (HE). And we evaluated the safety of modified dual antiplatelet therapy (DAPT) or triple antiplatelet therapy (TAPT) for clopidogrel hyporesponders. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus on August 19 2018. Data was collected the 1) incidence of TE between clopidogrel responder and clopidogrel hypo-responder, 2) incidence of HE between clopidogrel hyper-responder and clopidogrel responder and hypo-responder, and 3) incidence of TE and HE between modified DAPT or TAPT and standard DAPT in clopidogrel hypo-responder. High cut-off value of PRU was defined as PRU >40% or <220. Fifteen studies were enrolled. Clopidogrel responder showed lower incidence of TE than hypo-responder (risk ratio [RR], 0.32; 95% confidence interval [CI], 0.17-0.61; p<0.001). With the high cut-off value of PRU, clopidogrel responder showed more lower incidence of TE than hypo-responder (RR, 0.11; 95% CI, 0.02-0.45; p=0.002). The incidence of periprocedural HE have higher on clopidogrel hyper-responder than clopidogrel responder and hypo-responder (RR, 4.26; 95% CI, 1.10-16.44; p=0.04; I2=66%). The incidence of periprocedural TE after changing regimen of DAPT for clopidogrel hypo-responder have a tendency to reduce, but there was no significant difference between modified DAPT or TAPT group and standard DAPT group (p>0.05). The incidence of periprocedural HE after changing regimen of DAPT for clopidogrel hypo-responder was no significant difference between modified DAPT or TAPT group and standard DAPT group (p>0.05). PRU is a useful tool as a predictor of peri-procedural TE or HE on neurointervention. PRU has a threshold effect of cut-off value to predict the peri-procedural TE. Modified DAPT or TAPT to prevent TE in clopidogrel hypo-responders could not reduce the incidence of TE. We should investigate the further research about modification of regiment on neurointervention.

Keyword

Aneurysm; Thromboembolism; Hemorrhage; Clopidogrel; Blood platelets; P2Y12 reaction unit

Figure

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  Fig. 1. The Manhattan plot for single variant analysis of the SOX17 gene (shown in red dots) in 26 patients with intracranial aneurysms and 26 control subjects. The gray dotted line indicates statistical significance after correction for multiple testing.

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  Fig. 2. Quantile-quantile plot for single variant analysis of the SOX17 gene. This plot shows observed versus expected ordered -log10 (p-values). The shaded regions indicates standard errors [10].

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  Fig. 3. A regional plot of the rs12544958 variant’s position±500 kb with IA development. The purple diamond indicates a non-significant association of the rs12544958 variant of the SOX17 gene with IA. SNP : single nucleotide polymorphism, IA : intracranial aneurysm.

Reference

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