| Autor: |
Kim, Hyun Woo, Martinez-Gutierrez, Juan Carlos C, Dongarwar, Deepa, Tariq, Muhammad Bilal B, Ahmad, Mohammad Jamil J, Damato, Salvatore, Blackburn, Spiros, Sheth, Sunil, Chen, Peng R |
| Zdroj: |
Stroke (Ovid); February 2023, Vol. 54 Issue: Supplement 1 pA26-A26, 1p |
| Abstrakt: |
Introduction:Plavix resistance is an independent risk factor for thromboembolic complications following carotid artery stent (CAS) placements. The VerifyNow P2Y12 assay is the best studied in gauging for Plavix responsiveness. Its performance is affected when hematocrit (HCT) value is <33%, and the prevalence of anemia in acute stroke patients is 30%. Hence, we studied the effect of low HCT on P2Y12 response units (PRU) in patients with symptomatic carotid artery stenosis who received CAS.Methods:We included symptomatic carotid artery patients who suffered ischemic strokes and received CAS during the same hospitalization with PRU measured via VerifyNow assay. Therapeutic PRU is defined as ≤180. Primary outcomes were the comparisons of PRU and the proportion of non-responders between low (<33) and high (≥33) HCT groups. Secondary outcomes evaluated for switch in therapy in non-responders and the rate of major hemorrhages.Results:78 of 127 symptomatic carotid artery patients met inclusion criteria. Mean age was 70.5 with 38.5% females. 23 of 78 had HCT < 33. Baseline characteristics between low and high HCT groups were similar except for hemoglobin (9.4 vs. 12.7, p<0.01), HCT (28.2 vs. 37.5, p<0.01), diabetes (69.6 vs. 29.1%, p<0.01), pre-CAS antithrombotic load (Plavix 300mg load, 43.5 vs. 81.8%; Plavix 600mg load, 39.1 vs. 12.7%, p<0.01). Despite more aggressive pre-loading in low group, mean PRU was substantially higher (220.1 vs. 148.3, P<0.01) leading to higher proportion of non-responders (69.6 vs. 38.1%, p<0.01). 34 of 37 non-responders had changes from aspirin and Plavix 75mg to more aggressive therapeutic regimen. Rate of major hemorrhages was higher in non-responder low HCT group vs. the rest without significance (18.8 vs. 3.2%, p=0.15).Conclusion:In symptomatic carotid patients receiving CAS, low HCT is associated with increased PRU, resulting in some to be falsely categorized as non-responders receiving more aggressive therapy unnecessarily. |
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