Platelet Function and the Development of Thromboembolic Events After Cerebrovascular Stenting Procedures
Notice bibliographique
Résumé
Introduction: One of the biggest concerns associated with endovascular procedures is the development of thromboembolic events. To mitigate this risk, patients are placed on dual antiplatelet therapy. Interestingly, there is a known variation in one’s ability to appropriately respond to antiplatelet medications and patients with decreased responsiveness may be at an increased risk of developing ischemic complications. Routine testing of antiplatelet responsiveness is not performed at most endovascular centres and is still a topic of controversy within the neurosurgical community. The objective of our study was to determine if non-responsiveness to aspirin and clopidogrel was associated with the development of symptomatic thromboembolic events in patients undergoing cerebrovascular stenting procedures. Methods: A prospective study was conducted at the Foothills Medical Centre in Calgary, Alberta, Canada from August 2019 to February 2021. Patients undergoing cerebrovascular stenting procedures and who were on dual antiplatelet therapy consisting of aspirin and clopidogrel were enrolled in the study. Responsiveness to the antiplatelet medications was determined through whole blood impedance aggregometry and the treating neurointerventionalists were blinded to these results. The primary outcome was the development of a symptomatic thromboembolic event at 90 days after the procedure. Demographic, clinical, radiological, and procedural variables were analyzed to determine which factors were associated with the development of thromboembolic events. Results: One hundred and eighteen procedures were performed in 115 patients. The non-response rate of clopidogrel and aspirin was 21% and 14%, respectively. There were 12 (10%) thromboembolic events that occurred during the study period. On the univariable analysis age (p=0.03) and non-responsiveness to clopidogrel (p=0.01) were associated with the development of thromboembolic events, while aspirin non-responsiveness was not (p=0.13). On the multivariable logistic regression only clopidogrel non-responsiveness (OR 3.91, 95%CI 1.05, 14.50, p=0.04) was associated with the development of thromboembolic events. Conclusion: Our study has demonstrated that patients who were identified as clopidogrel non-responders, using whole blood impedance aggregometry, were at an increased risk of developing thromboembolic events. Furthermore, the results of our study validate the need for larger observational studies or randomized controlled trials to assess the utility of platelet function testing prior to cerebrovascular stenting procedures.
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 | 0,001 | 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 | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
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 ».