Heterogeneous practice patterns regarding antiplatelet medications for neuroendovascular stenting in the USA: a multicenter survey
- 3 January 2014
- journal article
- research article
- Published by BMJ in Journal of NeuroInterventional Surgery
- Vol. 6 (10), 774-779
- https://doi.org/10.1136/neurintsurg-2013-010954
Abstract
Background Adequate dual antiplatelet (AP) therapy is imperative when performing neurovascular stenting procedures. Currently, no consensus for the ideal AP regimen exists. Thus the present study aimed to gain a better understanding of real world practice AP patterns by surveying neurointerventional surgeons. Methods Survey links were emailed to 296 neurointerventional surgeons practicing in the USA, asking 51 questions including demographics, stent specific use, AP pre and post-medication, types of APs, point of care (POC) assessment, complications, and outcomes. Data were collected and analyzed using Research Electronic Data Capture (REDCap). Results 74 participants responded; 56.8% were from academic centers. Participants treated an average of 5.5 aneurysms per month. They placed an average of 1.6 intracranial stents and 1.4 cervical stents per month. Mean number of pipeline embolization devices (PEDs) placed per year was 15.2. Heterogeneity existed regarding AP regimens; the most frequent included acetylsalicylic acid (ASA) 325 mg+Plavix 75 mg daily (for 7 days prior) and ASA 325 mg+Plavix 75 mg daily (for 5 days prior) for routine placement of intracranial and cervical stents, respectively. For emergency placement, ASA 325 mg+Plavix 600 mg (at time of surgery) was the most frequently used. 46.8% routinely used POC testing, most frequently VerifyNow (Accumetrics, San Diego, California, USA); the most common threshold determining a non-responder was Conclusions The results highlight the heterogeneity of current practices regarding AP medication regimens during neurovascular stenting. Given its importance, evidence based protocols are imperative. Minimal literature exists focusing on neurovasculature, and therefore understanding current practice patterns represents a first step toward generating these protocols.Keywords
This publication has 27 references indexed in Scilit:
- Comparison of Flow Diversion and Coiling in Large Unruptured Intracranial Saccular AneurysmsStroke, 2013
- Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional proceduresJournal of NeuroInterventional Surgery, 2012
- Delayed Ipsilateral Parenchymal Hemorrhage Following Flow Diversion for the Treatment of Anterior Circulation AneurysmsAmerican Journal of Neuroradiology, 2012
- Change of Platelet Reactivity to Antiplatelet Therapy after Stenting Procedure for Cerebral Artery Stenosis: VerifyNow Antiplatelet Assay before and after StentingNeurointervention, 2012
- Novel use of prasugrel for intracranial stent thrombosisJournal of NeuroInterventional Surgery, 2011
- Hemorrhagic Complications Related to the Stent-Remodeled Coil Embolization of Intracranial AneurysmsNeurosurgery, 2010
- Anti-thrombotic medications for the neurointerventionist: aspirin and clopidogrelJournal of NeuroInterventional Surgery, 2010
- Neuroform stent assisted aneurysm treatment: evolving treatment strategies, complications and results of long term follow-upJournal of NeuroInterventional Surgery, 2009
- Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics supportJournal of Biomedical Informatics, 2008
- Hemorrhagic complications associated with stent-assisted coil embolizationJournal of Neurosurgery, 2008