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Dual Testing to Achieve Low On-treatment Platelet Reactivity for Aneurysm Embolization

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Abstract

Background and Purpose

Although point-of-care tests are used extensively to test platelet function before endovascular aneurysm treatment, their use and validity are still debated. We compared the results of two point-of-care tests (VerifyNow® and Multiplate®) for assessing patients treated with stents and flow diverters and determined their relation to periprocedural complications.

Methods

All patients undergoing treatment of intracranial aneurysms were tested using both methods and were retrospectively evaluated. Patients with acute subarachnoid hemorrhage and those who had to be maintained on anticoagulants for unrelated diseases were excluded. An acceptable level of platelet inhibition was required on both tests to commence with treatment, otherwise antiplatelet medication was adjusted to reach this level.

Results

Mean PRU (platelet reactivity units) and ADP AUC (adenosine diphosphate area under the aggregation curve) were 68 ± 66 and 23 ± 15, respectively, in 295 patients. Both tests showed a good correlation (r = 0.45). Both tests were able to predict hemorrhagic events but not ischemic events. When patients with very low reactivity (PRU < 60) were compared to the rest of the group, there were more hemorrhagic events in the first group but the overall rate of complications were similar (p = 0.27).

Conclusion

In this largest study comparing two widely used commercial platelet function tests, the correlation between the tests were less than ideal; however, the very low platelet reactivity attained by the help of dual platelet testing did not result in an increased overall complication rate.

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Authors and Affiliations

  1. Department of Radiology, Ministry of Health Ankara City Hospital, Ankara, Turkey

    Halitcan Batur

  2. Department of Neurology, Hacettepe University Hospitals, Ankara, Turkey

    Mehmet A. Topcuoglu & Ethem M. Arsava

  3. Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey

    Sinan Balci & Anil Arat

Authors
  1. Halitcan Batur
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  2. Mehmet A. Topcuoglu
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  3. Sinan Balci
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  4. Ethem M. Arsava
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  5. Anil Arat
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Contributions

H. Batur and M. A. Topcuoglu made substantial contribution to acquisition, analysis and interpretation of data; E. M. Arsava and A. Arat took part in conception and design of study; A. Arat performed final editing of the manuscript; all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Anil Arat.

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Conflict of interest

H. Batur, M. A. Topcuoglu, S. Balci, E. M. Arsava and A. Arat declare that they have no conflict of interests.

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards and were approved by the local ethics committee and comply with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Data is available from the corresponding author upon reasonable request.

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Batur, H., Topcuoglu, M.A., Balci, S. et al. Dual Testing to Achieve Low On-treatment Platelet Reactivity for Aneurysm Embolization. Clin Neuroradiol 31, 1159–1165 (2021). https://doi.org/10.1007/s00062-021-01011-7

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  • DOI: https://doi.org/10.1007/s00062-021-01011-7

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