Utility of Antiplatelet Therapy With Ticlopidine in Patients Refractory to Clopidogrel for Intracranial Stenting: A Single Institution Experience
Bibliographic record
Abstract
Background: The use of antiplatelets in intra-arterial stenting for cerebrovascular disease has been associated with a decrease in morbidity and mortality. Ticlopidine, a thienopyridine that inhibits ADP-mediated platelet aggregation, has been used with aspirin to treat patients with stroke and prevent thromboembolic occlusion in patients who have undergone endovascular procedures. Because of the reported side effects associated with ticlopidine such as bleeding, thrombocytopenic thrombotic purpura and neutropenia, another thienopyridine, clopidogrel, became the agent of choice as an antiplatelet regimen. However, as the literature accumulates, it is becoming evident that many patients are resistant or allergic to clopidogrel, thus highlighting the need for an alternative antiplatelet agent to prevent complications associated with endovascular management. Methods: After IRB approval, our patient database was retrospectively screened for patients who underwent a cerebral stent placement in which ticlopidine and aspirin was substituted for clopidogrel and aspirin. These patients were followed for signs and symptoms of cerebrovascular disease and complications of ticlopidine treatment. Results: From 2009 to 2011, seven patients were identified to be clopidogrel resistant and no patients identified as allergic. Resistance was defined as less than 15% platelet inhibition on the VerifyNow ® P2Y12 assay (Accumetrics Inc., San Diego, CA). Neither complications of cerebrovascular disease nor those associated with ticlopidine treatment were identified. Conclusions: Ticlopidine and aspirin may be an appropriate treatment alternative in patients who are resistant to clopidogrel and aspirin undergoing cerebral stenting. doi: http://dx.doi.org/10.4021/jnr142w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".