Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents.

Autor: May CC; Department of Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 214A Parks Hall, 500 12th Ave, Columbus, OH, 4321, USA. casey.may@osumc.edu., Holden D; Department of Pharmacy, Albany Medical Center, Albany, NY, USA., Robbins BT; Department of Pharmacy, University of Kentucky Healthcare, Lexington, KY, USA., Cook AM; Department of Pharmacy, University of Kentucky Healthcare, Lexington, KY, USA., Jung S; Wellstar Kennestone Hospital, Marietta, GA, USA., Smetana KS; The Ohio State Wexner Medical Center, Columbus, OH, USA., Roels C; Novant Health Forsyth Medical Center, Winston-Salem, NC, USA., Harlan SS; University of Cincinnati Medical Center, Cincinnati, OH, USA., Keegan S; University of Cincinnati Medical Center, Cincinnati, OH, USA., Brophy G; Virginia Commonwealth University, Richmond, VA, USA., Al Mohaish S; Virginia Commonwealth University, Richmond, VA, USA., Sandler M; Virginia Commonwealth University, Richmond, VA, USA., Spetz S; ProMedica Toledo Hospital, Toledo, OH, USA., Wohlfarth K; ProMedica Toledo Hospital, Toledo, OH, USA., Owusu-Guha J; OhioHealth Riverside Methodist Hospital, Columbus, OH, USA., Buschur P; OhioHealth Riverside Methodist Hospital, Columbus, OH, USA., Hetrick E; Tacoma General Hospital MultiCare Health System, Tacoma, WA, USA., Dombrowski K; University of South Florida/Tampa General Hospital, Tampa, FL, USA., Glover J; University of South Florida/Tampa General Hospital, Tampa, FL, USA., Levesque M; University of South Florida/Tampa General Hospital, Tampa, FL, USA., Dingman S; Wesley Medical Center, Wichita, KS, USA., Hussain M; Wesley Medical Center, Wichita, KS, USA.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2024 Feb; Vol. 40 (1), pp. 262-271. Date of Electronic Publication: 2023 Jun 15.
DOI: 10.1007/s12028-023-01749-7
Abstrakt: Background: Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T).
Methods: This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3-6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3-6 months after the procedure.
Results: Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p = 0.97) and no difference in any of the secondary safety outcomes.
Conclusions: Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.
(© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)
Databáze: MEDLINE
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