R implants.1 Literature from the field of interventional cardiology suggests that adding aspirin and clopidogrel dual antiplatelet therapy (DAPT) to postprocedural management minimizes the risk of thromboembolic complications2 and is far more beneficial than single agent therapy with aspirin alone.3e5 As a result, DAPT with full dose aspirin (325 mg orally every day) and clopidogrel (75 mg orally each day) has also been recommended for neurointerventional surgery.6 7 It has been estimated that around 30 of sufferers exhibit clopidogrel resistance.8 9 Importantly, cardiology research suggest that clopidogrel nonresponders exhibit a drastically greater price of stent thrombosis than these individuals who respond to this therapy (eight.236406-56-7 Chemical name 6 vs 2.three , respectively; p0.001).10 Within a potential study of more than 800 individuals, preprocedural platelet aggregation was related having a six.7fold threat of 30 day adverse events, including myocardial infarction, target lesion revascularization and death (p0.03).11 Those sufferers unresponsive to clopidogrel might be treated with newer generation antiplatelet agents. Prasugrel (Effient) can be a third generation oral thienopyridine that irreversibly inhibits the P2Y12 ADP receptor around the surface of platelets and decreases platelet aggregation.12 Prasugrel is usually a prodrug that is quickly metabolized to a pharmacologically active metabolite having a plasma halflife of w4 h.13 Although the medication costs for clopidogrel and prasugrel are equivalent,14 prasugrel affords far more potent and rapid inhibition of platelet aggregation15 and decreased intersubject response variability.457613-78-4 Chemscene 16 In randomized studies, DAPT with aspirin/ prasugrel was connected using a 30 enhance in the relative threat of bleeding (like fatal bleeding) compared with aspirin/clopidogrel, with out a considerable distinction in mortality.PMID:23880095 17 18 In yet another prospective multicentre trial of 396 individuals, Armero et al19 observed a bleeding price of 13.six (3.7 with main lifethreatening bleeding) in patients treated with aspirin/prasugrel DAPT for acute coronary syndrome. To date, even so, there have been no studies examining the security and efficacy of prasugrel for neurointerventional procedures. In this report, we detail our experience utilizing DAPT with aspirin/prasugrel within this patient population.METHODSFollowing approval by the Washington University Institutional Assessment Board, we retrospectively identified 115 consecutive subjects who underwent an interventional neuroradiology process atOpen Access Scan to access a lot more free of charge contentJ NeuroIntervent Surg 2013;5:33743. doi:10.1136/neurintsurg2012Clinical neurologyWashington University School of Medicine (Mallinckrodt Institute of Radiology, St Louis, Missouri, USA) by a single interventionalist (CJM) among 15 February 2010 and 31 October 2011. Subjects treated for intracranial aneurysms, arteriovenous malformations, dural arteriovenous fistula or intra/extracranial stenosis and who received DAPT for the duration of the pre and postprocedural periods had been incorporated. Patient charts were retrospectively reviewed for pre and postprocedure antiplatelet and anticoagulation therapy, at the same time as preoperative platelet counts, platelet function studies and coagulation parameters. Periprocedural activated clotting times had been also analyzed. All individuals had been loaded with aspirin (325 mg orally day-to-day) and clopidogrel (Plavix, BristolMyers Squibb/Sanofi Pharmaceuticals, Bridgewater, NJ, USA) (75 mg orally daily) no less than 7 days before their procedures. Those.