Puncture site bleeding complications in patients with Clopidogrel hyper-response
Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients...
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London Academic Publishing
2020-03-01
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doaj-c160505c5f1c4dba8aa41ce8d18e0d6d2020-11-25T03:32:10ZengLondon Academic PublishingRomanian Neurosurgery1220-88412344-49592020-03-01341Puncture site bleeding complications in patients with Clopidogrel hyper-responseNedeljković ŽarkoVukasinović IvanMajstorović BranisalvaMilosević Medenica SvetlanaMilićević MihailoIlić RosandaAleksić VukPaunović AleksandraStanimirovic AleksandarScepanović VukMilić MarinaTodorović MarkoMilisavljević FilipGrujičić Danica Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent. https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1340intracranial aneurysmsdual antiplatelet therapyClopidogrel hyper-response |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nedeljković Žarko Vukasinović Ivan Majstorović Branisalva Milosević Medenica Svetlana Milićević Mihailo Ilić Rosanda Aleksić Vuk Paunović Aleksandra Stanimirovic Aleksandar Scepanović Vuk Milić Marina Todorović Marko Milisavljević Filip Grujičić Danica |
spellingShingle |
Nedeljković Žarko Vukasinović Ivan Majstorović Branisalva Milosević Medenica Svetlana Milićević Mihailo Ilić Rosanda Aleksić Vuk Paunović Aleksandra Stanimirovic Aleksandar Scepanović Vuk Milić Marina Todorović Marko Milisavljević Filip Grujičić Danica Puncture site bleeding complications in patients with Clopidogrel hyper-response Romanian Neurosurgery intracranial aneurysms dual antiplatelet therapy Clopidogrel hyper-response |
author_facet |
Nedeljković Žarko Vukasinović Ivan Majstorović Branisalva Milosević Medenica Svetlana Milićević Mihailo Ilić Rosanda Aleksić Vuk Paunović Aleksandra Stanimirovic Aleksandar Scepanović Vuk Milić Marina Todorović Marko Milisavljević Filip Grujičić Danica |
author_sort |
Nedeljković Žarko |
title |
Puncture site bleeding complications in patients with Clopidogrel hyper-response |
title_short |
Puncture site bleeding complications in patients with Clopidogrel hyper-response |
title_full |
Puncture site bleeding complications in patients with Clopidogrel hyper-response |
title_fullStr |
Puncture site bleeding complications in patients with Clopidogrel hyper-response |
title_full_unstemmed |
Puncture site bleeding complications in patients with Clopidogrel hyper-response |
title_sort |
puncture site bleeding complications in patients with clopidogrel hyper-response |
publisher |
London Academic Publishing |
series |
Romanian Neurosurgery |
issn |
1220-8841 2344-4959 |
publishDate |
2020-03-01 |
description |
Dual antiplatelet therapy (clopidogrel and acetylsalicylic acid) is a standard for the embolization of planned intracranial aneurysms with CNS stent due to the possibility of stent thrombus formation. All anti-aggregation drugs, including those listed, have bleeding as a side effect. Three patients with aneurysm had an elevated response to antiplatelet therapy with clopidogrel, which was confirmed by a multiplate test on the "VerifyNow" system. After reducing the dose of clopidogrel or after interrupting it, with the introduction of low molecular weight heparin for the duration of five days, aneurysms were successfully resolved by intracranial implantation of the stent. Perioperative angiograms and postoperative CT angiograms have verified hematomas at the place of punction of the femoral artery. Bleeding was resolved by the femoral artery suture by a vascular surgeon. All patients were discharged home without further complications and with dual antiplatelet therapy. By measuring the platelet function in vitro, the degree of inhibition of platelet activity achieved by the action of the drug can be assessed. A specific test can identify those patients who are highly responsive to the drug with increased platelet reactivity and the possibility of increased risk of bleeding. Our suggestion is to reduce the dosage of clopidogrel or to leave it out for 24 hours with preventive doses of low molecular weight heparin or to change the strategy of treatment of intracranial aneurysm, i.e. avoiding implantation of CNS stent.
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topic |
intracranial aneurysms dual antiplatelet therapy Clopidogrel hyper-response |
url |
https://www.journals.lapub.co.uk/index.php/roneurosurgery/article/view/1340 |
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