E-127 Clopidogrel hyper-responsiveness is associated with hemorrhagic complications post cerebrovascular stenting procedures
Notice bibliographique
Résumé
Background Anti-platelet therapy is an important part of the treatment regimen in patients who are receiving a cerebrovascular stent, in order to reduce the incidence of thromboembolic complications. However, there is a known variation in patient response to anti-platelet medications. Theoretically, patients with decreased responsiveness may be at increased risk of ischemic complications while those with increased responsiveness may be at a heightened risk of bleeding. The objective of this investigation was to determine if patients with an increased response to clopidogrel were at an increased risk of developing post-procedural hematomas. Methods A prospective Research Ethics Board (REB) approved study was performed on consecutive patients undergoing endovascular placement of a cerebrovascular stent at the Foothills Medical Centre in Calgary, Alberta from 2019–2020. Inclusion criteria were patients over 18 years of age, and on dual anti-platelet therapy consisting of aspirin and clopidogrel for at least 3 days prior to the procedure. Platelet function testing was performed on blood samples taken before insertion of the stent using whole blood impedance aggregometry to determine the responsiveness to aspirin and clopidogrel. As per the REB protocol, treating neurointerventionalists were blinded to the aggregometry results. The primary study endpoint was the development of hemorrhagic complications during or after the procedure. Parametric and receiver operator curve analysis was used to assess for predictors of our primary outcome. Results To determine the cut-offs for ASA and clopidogrel responsiveness, whole blood aggregometry was first performed on 25 control patients who were not on anti-platelet agents. Subsequently, 50 consecutive patients undergoing cerebrovascular stenting procedures fit our inclusion criteria. 7 (14.0%) of these patients developed a hematoma either intracranially (n=1) or at the puncture site (n=6). Age, gender, smoking status, access site, or stent location were not associated with hemorrhagic complications. Based on our controls, ASA hyper-responders could not be identified using whole blood aggregometry due to the normal response being 0–1 ohms. With these cut-offs, however, 49 (98%) of our patients were responsive to aspirin. Using whole blood aggregometry on patients receiving a cerebrovascular stent, the optimal electrical impedance value was identified as <1 ohm (sensitivity 71.43%, specificity 74.42%, area under the curve 0.82) for clopidogrel hyper-responders. Of the 16 patients who had an impedance aggregometer value of 0–1 ohms for clopidogrel response, 5 (31.3%) of them developed a hematoma, while only 2 (6.7%) out of the 30 patients who had an aggregometer value of >2 ohms developed a hematoma. This association was found to be statistically significant (p=0.016). Conclusion Dual anti-platelet therapy is an important part of the treatment regimen in any patient who receives a cerebrovascular stent, but there are variations in patient response to these medications. Our study suggests that patients who have an increased response to clopidogrel may be at a higher risk of developing hemorrhagic complications. Disclosures S. Muram: None. K. Panchendrabose: None. M. Eagles: None. M. Suheel: None. A. Mitha: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».