Clopidogrel response predicts thromboembolic events associated with coil embolization of unruptured intracranial aneurysms: A prospective cohort study

Autor: Shoji Matsumoto, Takuro Hashikawa, Kazutaka Sonoda, Keisuke Tokunaga, Takuya Matsushita, Hiroyuki Murai, Ichiro Nakahara, Eiji Higashi, Takuma Ishihara, Atsushi Tsujimoto, Wataru Takita, Nobutake Sadamasa, Jun Ichi Kira, Koji Tanaka, Taketo Hatano, Tsuyoshi Ohta, Keitaro Matsuo, Mitsushige Ando, Takanari Kitazono, Hideo Chihara, Daisuke Kondo, Konosuke Furuta, Akira Ishii, Takahiko Kamata, Yusuke Funakoshi, Junpei Koge, Tetsuya Hashimoto
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Epidemiology
Infarction
Vascular Medicine
Endocrinology
Medical Conditions
Mathematical and Statistical Techniques
Medicine and Health Sciences
Prospective Studies
Prospective cohort study
Multidisciplinary
Cerebral infarction
Statistics
Arteries
Middle Aged
Embolization
Therapeutic
Clopidogrel
Physical Sciences
Cardiology
Medicine
Female
Anatomy
Aneurysms
Cohort study
Research Article
medicine.medical_specialty
Endocrine Disorders
Science
Research and Analysis Methods
Aneurysm
Signs and Symptoms
Internal medicine
Thromboembolism
medicine
Diabetes Mellitus
Humans
cardiovascular diseases
Vascular Diseases
Thrombus
Statistical Methods
Aged
business.industry
Biology and Life Sciences
Intracranial Aneurysm
Nomogram
Cerebral Arteries
medicine.disease
Blood Vessel Prosthesis
Dyslipidemia
Medical Risk Factors
Metabolic Disorders
Cardiovascular Anatomy
Blood Vessels
Clinical Medicine
Complication
business
Mathematics
Platelet Aggregation Inhibitors
Forecasting
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 4, p e0249766 (2021)
ISSN: 1932-6203
Popis: Objective Periprocedural thromboembolic events are a serious complication associated with coil embolization of unruptured intracranial aneurysms. However, no established clinical rule for predicting thromboembolic events exists. This study aimed to clarify the significance of adding preoperative clopidogrel response value to clinical factors when predicting the occurrence of thromboembolic events during/after coil embolization and to develop a nomogram for thromboembolic event prediction. Methods In this prospective, single-center, cohort study, we included 345 patients undergoing elective coil embolization for unruptured intracranial aneurysm. Thromboembolic event was defined as the occurrence of intra-procedural thrombus formation and postprocedural symptomatic cerebral infarction within 7 days. We evaluated preoperative clopidogrel response and patients’ clinical information. We developed a patient-clinical-information model for thromboembolic event using multivariate analysis and compared its efficiency with that of patient-clinical-information plus preoperative clopidogrel response model. The predictive performances of the two models were assessed using area under the receiver-operating characteristic curve (AUC-ROC) with bootstrap method and compared using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results Twenty-eight patients experienced thromboembolic events. The clinical model included age, aneurysm location, aneurysm dome and neck size, and treatment technique. AUC-ROC for the clinical model improved from 0.707 to 0.779 after adding the clopidogrel response value. Significant intergroup differences were noted in NRI (0.617, 95% CI: 0.247–0.987, p < .001) and IDI (0.068, 95% CI: 0.021–0.116, p = .005). Conclusions Evaluation of preoperative clopidogrel response in addition to clinical variables improves the prediction accuracy of thromboembolic event occurrence during/after coil embolization of unruptured intracranial aneurysm.
Databáze: OpenAIRE
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