Abstract
Purpose
The effectiveness and safety of low-dose prasugrel (PSG) premedication for endovascular treatment of unruptured intracranial aneurysms (UIAs) have been widely reported. In this study, we evaluated the clinical outcomes of elders patients (≥ 75 years) treated with PSG.
Methods
A total of 200 patients with 209 UIAs who were administered PSG as premedication (20 mg loading and 5 mg maintenance with 100 mg aspirin) between March 2018 and December 2021 were retrospectively enrolled. Among them, 39 patients were aged 75 years or over (elders group), and 161 patients were aged under 75 years (control group). Patients’ clinical data were collected, and outcomes were compared between the two groups.
Results
Of the 200 patients with PSG, 9 cases (4.5%) had overall complications (7 ischemic, 2 hemorrhagic). In the comparison between the elders group and the control group, no significant differences were observed in the overall complication rates (elders group vs. control group; 2.6% vs. 5.0%, P = 1.00). Moreover, the rates of poor clinical outcome were comparable (2.6% vs. 1.2%, P = 0.48). The subgroup analysis of patients with stent-assisted procedures revealed no significant differences in complication rates (0% vs. 1.6%, P = 1.00) or poor clinical outcomes (0% vs. 0%, P = 1.00) during maintenance with aspirin 100 mg or PSG 5 mg.
Conclusion
The complication rates in the elders treated with low-dose PSG premedication were similar to those in the control. Low-dose PSG premedication could be prescribed without any additional risk for the endovascular treatment of UIAs in elders patients.
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References
Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, Oh CW. Trends in the incidence and treatment of cerebrovascular diseases in Korea: part I. Intracranial aneurysm, intracerebral hemorrhage, and arteriovenous malformation. J Korean Neurosurg Soc. 2020;63:56–68.
Gonzalez NR, Dusick JR, Duckwiler G, Tateshima S, Jahan R, Martin NA, Viñuela F. Endovascular coiling of intracranial aneurysms in elderly patients: report of 205 treated aneurysms. Neurosurgery. 2010;66:714–20; discussion 720–1.
Kang HS, Kwon BJ, Kim JE, Han MH. Preinterventional clopidogrel response variability for coil embolization of intracranial aneurysms: clinical implications. AJNR Am J Neuroradiol. 2010;31:1206–10.
Leslie-Mazwi TM, Chandra RV, Oh DC, Nogueira RG. Novel use of prasugrel for intracranial stent thrombosis. J Neurointerv Surg. 2011;3:358–60.
Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–15.
Kitagawa K, Toyoda K, Kitazono T, Nishikawa M, Nanto S, Ikeda Y, Abe K, Ogawa A. Safety and efficacy of prasugrel in elderly/low body weight Japanese patients with ischemic stroke: randomized PRASTRO-II. Cerebrovasc Dis. 2020;49:152–9.
Ha EJ, Cho WS, Kim JE, Cho YD, Choi HH, Kim T, Bang JS, Hwang G, Kwon OK, Oh CW, Han MH, Kang HS. Prophylactic antiplatelet medication in endovascular treatment of intracranial aneurysms: low-dose prasugrel versus clopidogrel. AJNR Am J Neuroradiol. 2016;37:2060–5.
Choi HH, Lee JJ, Cho YD, Han MH, Cho WS, Kim JE, An SJ, Mun JH, Yoo DH, Kang HS. Antiplatelet premedication for stent-assisted coil embolization of intracranial aneurysms: low-dose prasugrel vs clopidogrel. Neurosurgery. 2018;83:981–8.
Cho WS, Lee J, Ha EJ, Kim KH, Lee J, Cho YD, Kim JE, Han MH, Kang HS. Low-dose prasugrel vs clopidogrel-based tailored premedication for endovascular treatment of cerebral aneurysms. Neurosurgery. 2019;85:E52–E9.
Cagnazzo F, Perrini P, Lefevre PH, Gascou G, Dargazanli C, Riquelme C, Derraz I, di Carlo D, Bonafe A, Costalat V. Comparison of prasugrel and clopidogrel used as antiplatelet medication for endovascular treatment of unruptured intracranial aneurysms: a meta-analysis. AJNR Am J Neuroradiol. 2019;40:681–6.
Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, Bell WR, Knatterud G, Robertson TL, Terrin ML. Thrombolysis in myocardial infarction (TIMI) trial—phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol. 1988;11:1–11.
Faught RW, Satti SR, Hurst RW, Pukenas BA, Smith MJ. Heterogeneous practice patterns regarding antiplatelet medications for neuroendovascular stenting in the USA: a multicenter survey. J Neurointerv Surg. 2014;6:774–9.
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ, ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407–77.
Wiviott SD. Intensity of antiplatelet therapy in patients with acute coronary syndromes and percutaneous coronary intervention: the promise of prasugrel? Cardiol Clin. 2008;26:629–37.
Akbari SH, Reynolds MR, Kadkhodayan Y, Cross DT 3rd, Moran CJ. Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures. J Neurointerv Surg. 2013;5:337–43.
Lee D, Song Y, Han M, Park D, Suh DC. Low-dose prasugrel in patients with resistance to clopidogrel for the treatment of cerebral aneurysms. Neurointervention. 2018;13:124–7.
Higashiguchi S, Sadato A, Nakahara I, Matsumoto S, Hayakawa M, Adachi K, Hasebe A, Suyama Y, Omi T, Yamashiro K, Wakako A, Ishihara T, Kawazoe Y, Kumai T, Tanabe J, Suyama K, Watanabe S, Suzuki T, Hirose Y. Reduction of thromboembolic complications during the endovascular treatment of unruptured aneurysms by employing a tailored dual antiplatelet regimen using aspirin and prasugrel. J Neurointerv Surg. 2021;13:1044–8.
Niimi J, Takahashi Y, Ueda K, Tasaka K, Tsuruoka A, Nemoto F, Moriwaki T, Hatayama K, Otake M, Naito H. The usefulness of prasugrel as rescue medication in neuroendovascular therapy. J Neuroendovasc Ther. 2020;14:90–5.
Kurniawan RG, Song Y, Kwon B, Ahn Y, Suh DC. Tailored antiplatelet agent medication in clopidogrel hyporesponsive patients before stent-assisted coiling: single-center experience. Neuroradiology. 2020;62:1709–15.
Jones GM, Twilla JD, Hoit DA, Arthur AS. Prevention of stent thrombosis with reduced dose of prasugrel in two patients undergoing treatment of cerebral aneurysms with pipeline embolisation devices. J Neurointerv Surg. 2013;5:e38.
Oran I, Cinar C, Gok M, Duzgun F. Aggregometry response to half-dose prasugrel in flow-diverting stent implantation. Clin Neuroradiol. 2020;30:463–9.
Small DS, Wrishko RE, Ernest CS 2nd, Ni L, Winters KJ, Farid NA, Li YG, Salazar DE, Payne CD. Effect of age on the pharmacokinetics and pharmacodynamics of prasugrel during multiple dosing: an open-label, single-sequence, clinical trial. Drugs Aging. 2009;26:781–90.
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S.H. Lee, H.H. Choi, K. Min Jang, T. Kyun Nam and J. Soo Byun declare that they have no competing interests.
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Lee, S.H., Choi, H.H., Jang, K.M. et al. Safety and Efficacy of Low-dose Prasugrel in the Endovascular Treatment of Unruptured Aneurysms in the Elders (≥ 75 Years). Clin Neuroradiol 33, 179–186 (2023). https://doi.org/10.1007/s00062-022-01199-2
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DOI: https://doi.org/10.1007/s00062-022-01199-2