Comparison of Prasugrel and Clopidogrel Used as Antiplatelet Medication for Endovascular Treatment of Unruptured Intracranial Aneurysms: A Meta-Analysis
| Autor: | I. Derraz, Paolo Perrini, Cyril Dargazanli, Vincent Costalat, F. Cagnazzo, Alain Bonafe, C. Riquelme, Pierre-Henri Lefevre, D. di Carlo, G. Gascou |
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| Přispěvatelé: | Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), University of Pisa - Università di Pisa, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier) |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
Prasugrel medicine.medical_treatment Premedication Hemorrhage 030218 nuclear medicine & medical imaging Brain Ischemia 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Humans Radiology Nuclear Medicine and imaging Embolization Endovascular treatment MESH: Brain Ischemia/etiology Chlopidogrel/therapeutic use Endovascular Procedures/adverse effects Intracranial Aneurism/therapy Platelet Aggregation Inhibitors/therapeutic use Postoperative Complications/prevention&control; Prasugrel Hydrochloride/therapeutic use Aged Retrospective Studies Interventional business.industry Endovascular Procedures High loading Retrospective cohort study Intracranial Aneurysm [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences Middle Aged Clopidogrel Embolization Therapeutic 3. Good health Treatment Outcome Anesthesia Meta-analysis [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Female Neurology (clinical) business Prasugrel Hydrochloride 030217 neurology & neurosurgery Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | AJNR. American journal of neuroradiology AJNR. American journal of neuroradiology, 1970, 40 (4), pp.681-686. ⟨10.3174/ajnr.A6004⟩ |
| ISSN: | 1936-959X |
| DOI: | 10.3174/ajnr.A6004⟩ |
| Popis: | BACKGROUND: Clopidogrel is routinely used to decrease ischemic complications during neurointerventional procedures. However, the efficacy may be limited by antiplatelet resistance. PURPOSE: Our aim was to analyze the efficacy of prasugrel compared with clopidogrel in the cerebrovascular field. DATA SOURCES: A systematic search of 2 large databases was performed for studies published from 2000 to 2018. STUDY SELECTION: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included studies reporting treatment-related outcomes of patients undergoing neurointerventional procedures under prasugrel, and studies comparing prasugrel and clopidogrel. DATA ANALYSIS: Random-effects meta-analysis was used to pool the overall rate of complications, ischemic and hemorrhagic events, and influence of the dose of prasugrel. DATA SYNTHESIS: In the 7 included studies, 682 and 672 unruptured intracranial aneurysms were treated under prasugrel (cases) and clopidogrel (controls), respectively. Low-dose (20 mg/5 mg; loading and maintenance doses) prasugrel compared with the standard dose of clopidogrel (300 mg/75 mg) showed a significant reduction in the complication rate (OR = 0.36; 95% CI, 0.17–74, P = .006; I 2 = 0%). Overall, the ischemic complication rate was significantly higher in the clopidogrel group (40/672 = 6%; 95% CI, 3%–13%; I 2 = 83% versus 16/682 = 2%; 95% CI, 1%–5%; I 2 = 73%; P = .03). Low and high loading doses of prasugrel were associated with 0.6% (5/535; 95% CI, 0.1%–1.6%; I 2 = 0%) and 9.3% (13/147; 95% CI, 0.2%–18%; I 2 = 60%) intraperiprocedural hemorrhages, respectively ( P = .001), whereas low and high maintenance doses of prasugrel were associated with 0% (0/433) and 0.9% (2/249; 95% CI, 0.3%–2%; I 2 = 0%) delayed hemorrhagic events, respectively ( P = .001). LIMITATIONS: Retrospective series and heterogeneous endovascular treatments were limitations. CONCLUSIONS: In our study, low-dose prasugrel compared with clopidogrel premedication was associated with an effective reduction of the ischemic events with an acceptable rate of hemorrhagic complications. |
| Databáze: | OpenAIRE |
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