The Efficacy of P2Y12 Reactive Unit to Predict the Periprocedural Thromboembolic and Hemorrhagic Complications According to Clopidogrel Responsiveness and Safety of Modification of Dual Antiplatelet Therapy : A Meta-Analysisopen access
- Authors
- Kim, Hyun Jung; Oh, Jae Sang; Park, Sukh Que; Yoon, Seok Mann; Ahn, Hyeong Sik; Kim, Bum Tae
- Issue Date
- Sep-2020
- Publisher
- 대한신경외과학회
- Keywords
- Aneurysm; Thromboembolism; Hemorrhage; Clopidogrel; Blood platelets; P2Y12 reaction unit
- Citation
- Journal of Korean Neurosurgical Society, v.63, no.5, pp 539 - 549
- Pages
- 11
- Journal Title
- Journal of Korean Neurosurgical Society
- Volume
- 63
- Number
- 5
- Start Page
- 539
- End Page
- 549
- URI
- https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/2520
- DOI
- 10.3340/jkns.2019.0082
- ISSN
- 2005-3711
1598-7876
- Abstract
- The efficacy of P2Y12 reaction unit (PRU) of VerifyNow still remains as a controversial issue in neurointervention. So we investigated the usefulness of PRU of VerifyNow to predict the peri-procedural thromboembolic events (TE) and hemorrhagic events (HE). And we evaluated the safety of modified dual antiplatelet therapy (DAPT) or triple antiplatelet therapy (TAPT) for clopidogrel hyporesponders. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Scopus on August 19 2018. Data was collected the 1) incidence of TE between clopidogrel responder and clopidogrel hypo-responder, 2) incidence of HE between clopidogrel hyper-responder and clopidogrel responder and hypo-responder, and 3) incidence of TE and HE between modified DAPT or TAPT and standard DAPT in clopidogrel hypo-responder. High cut-off value of PRU was defined as PRU >40% or <220. Fifteen studies were enrolled. Clopidogrel responder showed lower incidence of TE than hypo-responder (risk ratio [RR], 0.32; 95% confidence interval [CI], 0.17-0.61; p<0.001). With the high cut-off value of PRU, clopidogrel responder showed more lower incidence of TE than hypo-responder (RR, 0.11; 95% CI, 0.02-0.45; p=0.002). The incidence of periprocedural HE have higher on clopidogrel hyper-responder than clopidogrel responder and hypo-responder (RR, 4.26; 95% CI, 1.10-16.44; p=0.04; I-2 =66%). The incidence of periprocedural TE after changing regimen of DAPT for clopidogrel hypo-responder have a tendency to reduce, but there was no significant difference between modified DAPT or TAPT group and standard DAPT group (p>0.05). The incidence of periprocedural HE after changing regimen of DAPT for clopidogrel hypo-responder was no significant difference between modified DAPT or TAPT group and standard DAPT group (p>0.05). PRU is a useful tool as a predictor of peri-procedural TE or HE on neurointervention. PRU has a threshold effect of cut-off value to predict the peri procedural TE. Modified DAPT or TAPT to prevent TE in clopidogrel hypo-responders could not reduce the incidence of TE. We should investigate the further research about modification of regiment on neurointervention.
- Files in This Item
- There are no files associated with this item.
- Appears in
Collections - College of Medicine > Department of Neurosurgery > 1. Journal Articles
- College of Medicine > Department of Neurosurgery > 1. Journal Articles
- College of Medicine > Department of Neurosurgery > 1. Journal Articles
![qrcode](https://api.qrserver.com/v1/create-qr-code/?size=55x55&data=https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/2520)
Items in ScholarWorks are protected by copyright, with all rights reserved, unless otherwise indicated.