Multicenter comparison of antiplatelet treatment strategies for urgent/emergent neuroendovascular stenting.
| Autor: | Holden D; Department of Pharmacy, Albany Medical Center, Albany, NY, USA., May CC; Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, 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., Smetana KS; The Ohio State Wexner Medical Center., Roels C; Novant Health Forsyth Medical Center., Harlan SS; University of Cincinnati Medical Center., Keegan S; University of Cincinnati Medical Center., Brophy G; Virginia Commonwealth University., Al Mohaish S; Virginia Commonwealth University., Sandler M; Virginia Commonwealth University., Spetz S; ProMedica Toledo Hospital., Wohlfarth K; ProMedica Toledo Hospital., Owusu-Guha J; OhioHealth Riverside Methodist Hospital., Buschur P; OhioHealth Riverside Methodist Hospital., Hetrick E; Tacoma General Hospital MultiCare Health System., Dombrowski K; University of South Florida/Tampa General Hospital., Glover J; University of South Florida/Tampa General Hospital., Levesque M; University of South Florida/Tampa General Hospital., Dingman S; Wesley Medical Center., Hussain M; Wesley Medical Center. |
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| Jazyk: | angličtina |
| Zdroj: | Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2023 Jul 04, pp. 15910199231180003. Date of Electronic Publication: 2023 Jul 04. |
| DOI: | 10.1177/15910199231180003 |
| Abstrakt: | Background: Emergent neuroendovascular stenting presents challenges for the utilization of antiplatelet agents. Methods: This was a multicenter, retrospective cohort of patients who underwent emergent neuroendovascular stenting. The primary endpoints were thrombotic and bleeding events in relation to the timing of antiplatelet administration, route of administration, and choice of intravenous (IV) agent and the study investigated practice variability in antiplatelet utilization. Results: Five-hundred and seventy patients were screened across 12 sites. Of those, 167 were included for data analysis. For patients who presented with ischemic stroke, artery dissection and emergent internal carotid artery (ICA) stenting who received an antiplatelet agent prior to or during the procedure, 57% were given an IV antiplatelet agent; for patients who were given an antiplatelet agent after the procedure, 96% were given an oral agent. For patients who presented for aneurysm repair and received an antiplatelet agent prior to or during the procedure, 74% were given an IV agent; patients who were given an antiplatelet agent after the completion of the procedure were given an oral antiplatelet agent 90% of the time. In patients who presented with ischemic stroke, artery dissection and emergent ICA stenting who received oral antiplatelet agents post-procedure were more likely to have thrombotic events compared to those who received oral antiplatelet agents prior to or during the procedure (29% vs 9%; p = 0.04). There were no differences in the primary outcomes observed when comparing other antiplatelet treatment strategies. Conclusion: The optimal timing of antiplatelet administration in relation to stent placement and route of administration of antiplatelet agents is unclear. Timing and route of administration of antiplatelet agents may have an effect on thrombosis in emergent neuroendovascular stenting. Significant practice variation exists in antiplatelet agent utilization in emergent neuroendovascular stenting. |
| Databáze: | MEDLINE |
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