Neuro-Interventional Use of Oral Antiplatelets: A Survey of Neuro-Endovascular Centers in the United States and Review of the Literature

Salia Farrokh, Kent Owusu, Lucia Rivera Lara, Katharine Nault, Ferdinand Hui, Brian Spoelhof

Research output: Contribution to journalArticle

Abstract

Background: Intra- and postprocedural thrombosis are major complication of aneurysmal coil embolization, stent-assisted coiling, and pipeline embolization. The common but unproven practice of dual antiplatelet therapy with aspirin and a P2Y12 inhibitor in neuro-endovascular patients is inferred from the cardiology literature without large clinical trials to support it in neuro-endovascular patients. Objective: We conducted an electronic survey to identify practice variations surrounding the use of oral antiplatelets in patients undergoing endovascular neuro-interventional procedures across neuro-endovascular centers in the United States. Methods: An electronic survey was distributed via the Web. Any practicing neuro-intensive care unit (ICU), neuro-interventional or stroke physician, pharmacist, physician assistant, or nurse practitioner was eligible to respond to this survey between June and October 2017. Results: A total of 33 responses were collected during the survey period. A response rate of 16% was calculated after taking into account all comprehensive stroke centers in the United States. Aspirin and clopidogrel was the standard-of-care antiplatelet regimen utilized in the majority of institutions (82%). Alternatively, 4 institutions used monotherapy (aspirin [n = 2], clopidogrel [n = 1], either aspirin or clopidogrel [n = 1]) and 2 institutions reported practitioner-dependent practices. Just under half of the centers reported ticagrelor as the primary alternative in clopidogrel nonresponders (48%). Conclusion: Dual antiplatelet therapy with aspirin and clopidogrel appears to be standard of care in this setting based on our survey. About half of responding institutions use ticagrelor in cases where clopidogrel resistance is suspected. Large society-wide patient registries are needed to provide data for future safety and efficacy studies.

Original languageEnglish (US)
JournalJournal of Pharmacy Practice
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

clopidogrel
Aspirin
Standard of Care
Stroke
Physician Assistants
Nurse Practitioners
Cardiology
Pharmacists
Stents
Intensive Care Units
Registries
Surveys and Questionnaires
Thrombosis
Clinical Trials

Keywords

  • antiplatelet
  • clopidogrel
  • neuro-intervention
  • prasugrel
  • ticagrelor

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Neuro-Interventional Use of Oral Antiplatelets : A Survey of Neuro-Endovascular Centers in the United States and Review of the Literature. / Farrokh, Salia; Owusu, Kent; Rivera Lara, Lucia; Nault, Katharine; Hui, Ferdinand; Spoelhof, Brian.

In: Journal of Pharmacy Practice, 01.01.2019.

Research output: Contribution to journalArticle

@article{6889b4f70798474ba87f939ae213d72a,
title = "Neuro-Interventional Use of Oral Antiplatelets: A Survey of Neuro-Endovascular Centers in the United States and Review of the Literature",
abstract = "Background: Intra- and postprocedural thrombosis are major complication of aneurysmal coil embolization, stent-assisted coiling, and pipeline embolization. The common but unproven practice of dual antiplatelet therapy with aspirin and a P2Y12 inhibitor in neuro-endovascular patients is inferred from the cardiology literature without large clinical trials to support it in neuro-endovascular patients. Objective: We conducted an electronic survey to identify practice variations surrounding the use of oral antiplatelets in patients undergoing endovascular neuro-interventional procedures across neuro-endovascular centers in the United States. Methods: An electronic survey was distributed via the Web. Any practicing neuro-intensive care unit (ICU), neuro-interventional or stroke physician, pharmacist, physician assistant, or nurse practitioner was eligible to respond to this survey between June and October 2017. Results: A total of 33 responses were collected during the survey period. A response rate of 16{\%} was calculated after taking into account all comprehensive stroke centers in the United States. Aspirin and clopidogrel was the standard-of-care antiplatelet regimen utilized in the majority of institutions (82{\%}). Alternatively, 4 institutions used monotherapy (aspirin [n = 2], clopidogrel [n = 1], either aspirin or clopidogrel [n = 1]) and 2 institutions reported practitioner-dependent practices. Just under half of the centers reported ticagrelor as the primary alternative in clopidogrel nonresponders (48{\%}). Conclusion: Dual antiplatelet therapy with aspirin and clopidogrel appears to be standard of care in this setting based on our survey. About half of responding institutions use ticagrelor in cases where clopidogrel resistance is suspected. Large society-wide patient registries are needed to provide data for future safety and efficacy studies.",
keywords = "antiplatelet, clopidogrel, neuro-intervention, prasugrel, ticagrelor",
author = "Salia Farrokh and Kent Owusu and {Rivera Lara}, Lucia and Katharine Nault and Ferdinand Hui and Brian Spoelhof",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0897190019854868",
language = "English (US)",
journal = "Journal of Pharmacy Practice",
issn = "0897-1900",
publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - Neuro-Interventional Use of Oral Antiplatelets

T2 - A Survey of Neuro-Endovascular Centers in the United States and Review of the Literature

AU - Farrokh, Salia

AU - Owusu, Kent

AU - Rivera Lara, Lucia

AU - Nault, Katharine

AU - Hui, Ferdinand

AU - Spoelhof, Brian

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Intra- and postprocedural thrombosis are major complication of aneurysmal coil embolization, stent-assisted coiling, and pipeline embolization. The common but unproven practice of dual antiplatelet therapy with aspirin and a P2Y12 inhibitor in neuro-endovascular patients is inferred from the cardiology literature without large clinical trials to support it in neuro-endovascular patients. Objective: We conducted an electronic survey to identify practice variations surrounding the use of oral antiplatelets in patients undergoing endovascular neuro-interventional procedures across neuro-endovascular centers in the United States. Methods: An electronic survey was distributed via the Web. Any practicing neuro-intensive care unit (ICU), neuro-interventional or stroke physician, pharmacist, physician assistant, or nurse practitioner was eligible to respond to this survey between June and October 2017. Results: A total of 33 responses were collected during the survey period. A response rate of 16% was calculated after taking into account all comprehensive stroke centers in the United States. Aspirin and clopidogrel was the standard-of-care antiplatelet regimen utilized in the majority of institutions (82%). Alternatively, 4 institutions used monotherapy (aspirin [n = 2], clopidogrel [n = 1], either aspirin or clopidogrel [n = 1]) and 2 institutions reported practitioner-dependent practices. Just under half of the centers reported ticagrelor as the primary alternative in clopidogrel nonresponders (48%). Conclusion: Dual antiplatelet therapy with aspirin and clopidogrel appears to be standard of care in this setting based on our survey. About half of responding institutions use ticagrelor in cases where clopidogrel resistance is suspected. Large society-wide patient registries are needed to provide data for future safety and efficacy studies.

AB - Background: Intra- and postprocedural thrombosis are major complication of aneurysmal coil embolization, stent-assisted coiling, and pipeline embolization. The common but unproven practice of dual antiplatelet therapy with aspirin and a P2Y12 inhibitor in neuro-endovascular patients is inferred from the cardiology literature without large clinical trials to support it in neuro-endovascular patients. Objective: We conducted an electronic survey to identify practice variations surrounding the use of oral antiplatelets in patients undergoing endovascular neuro-interventional procedures across neuro-endovascular centers in the United States. Methods: An electronic survey was distributed via the Web. Any practicing neuro-intensive care unit (ICU), neuro-interventional or stroke physician, pharmacist, physician assistant, or nurse practitioner was eligible to respond to this survey between June and October 2017. Results: A total of 33 responses were collected during the survey period. A response rate of 16% was calculated after taking into account all comprehensive stroke centers in the United States. Aspirin and clopidogrel was the standard-of-care antiplatelet regimen utilized in the majority of institutions (82%). Alternatively, 4 institutions used monotherapy (aspirin [n = 2], clopidogrel [n = 1], either aspirin or clopidogrel [n = 1]) and 2 institutions reported practitioner-dependent practices. Just under half of the centers reported ticagrelor as the primary alternative in clopidogrel nonresponders (48%). Conclusion: Dual antiplatelet therapy with aspirin and clopidogrel appears to be standard of care in this setting based on our survey. About half of responding institutions use ticagrelor in cases where clopidogrel resistance is suspected. Large society-wide patient registries are needed to provide data for future safety and efficacy studies.

KW - antiplatelet

KW - clopidogrel

KW - neuro-intervention

KW - prasugrel

KW - ticagrelor

UR - http://www.scopus.com/inward/record.url?scp=85070417622&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070417622&partnerID=8YFLogxK

U2 - 10.1177/0897190019854868

DO - 10.1177/0897190019854868

M3 - Article

C2 - 31327286

AN - SCOPUS:85070417622

JO - Journal of Pharmacy Practice

JF - Journal of Pharmacy Practice

SN - 0897-1900

ER -