Correlation Between Antiplatelet Drug Sensitivity And Postoperative Thrombotic Events Treated With Flow Diverter

Objective: To investigate the value of thromboelastography for guiding postoperative antiplatelet medication in patients with intracranial aneurysms treated with flow diverter(FD).Method(s): This article retrospectively analyzes 85 patients diagnosed with intracranial aneurysm and successfully treated with FD in the Department of Cerebrovascular Diseases of the Second Affiliated Hospital of Guilin Medical College from August 2020 to February 2022.All patients were treated with aspirin combined with clopidogrel regimen,and two thromboelastography(TEG)tests were performed during hospitalization,at least 3 days of preoperative dosing and at least 1 week of postoperative dosing,to assess the effect of antiplatelet aggregation drugs.Based on the TEG test results,aspirin responsiveness was determined as low when the inhibition rate of AA test was<50%,i.e.,aspirin resistance(AR),good when the inhibition rate of AA test was≥50%,i.e.,aspirin sensitivity;clopidogrel responsiveness was determined as low when the inhibition rate of ADP test was <30%,i.e.,clopidogrel resistance(CR),when the inhibition rate of ADP test was ≥30% The patients were grouped in this way.1 Baseline clinical data and aspirin and clopidogrel drug responsiveness indicators were collected,and patients were divided into aspirin-resistant,aspirin-sensitive,clopidogrel-resistant,and clopidogrel-sensitive groups based on thromboelastography.2 Factors influencing aspirin and clopidogrel drug responsiveness were analyzed.3 Based on the hospital center’s aspirin-combined clopidogrel treatment regimen,patients with CR were treated with aspirin and clopidogrel.Patients with CR were replaced with ticagrelor immediately after surgery and included in the ticagrelor group,and their ADP and AA test suppression rates were analyzed for drug association.4 Patients were grouped according to whether they had a thromboembolic event within six months after surgery,defined as acute intraoperative thrombosis and distant imaging suggestive of in-stent restenosis,and were divided into thromboembolic and non-thromboembolic groups.The patients were divided into thromboembolic and non-thromboembolic groups,and the ADP and AA test suppression rates were compared between the two groups to find the risk factors affecting the occurrence of thromboembolic events.Result(s):.1 A total of 85 patients were included,and 14(16.47%)had clopidogrel resistance,18(21.17%)had aspirin resistance,and 10(11.76%)had dual resistance to aspirin and clopidogrel by TEG.2 The correlation between ADP and AA test inhibition rates in patients before FD treatment was low(r=0.35,P<0.05);3 A statistically significant difference in the rate of ADP test inhibition was observed when comparing the tigretol group with the clopidogrel-sensitive group at 1 week postoperatively(P=0.034,P<0.05).4Follow-up outcomes at 6 months postoperatively: 3 cases were lost to follow-up and 1 case died.Among them,44 cases(52.19%)had complete healing,22 cases(26.19%)had morphological improvement,and 15 cases(17.86%)had no improvement.24 intraoperative or postoperative-related complications included1 fatal aneurysm rupture,3 cases of intracerebral parenchymal rebleeding,1case of intraoperative acute thrombosis and 6 cases of distant in-stent restenosis,and 13 cases of lacunar cerebral infarction.the incidence of adverse cerebrovascular events in the CR group was higher than that in the clopidogrel-responsive group,with a significant difference(P < 0.001).5 In 7 of85 patients(8.24%),thromboembolic events occurred,and the rate of AA test inhibition between the thromboembolic and nonthromboembolic groups was analyzed,with no statistically significant difference(P > 0.05);the rate of ADP inhibition in the thromboembolic group was significantly lower than that in the nonthromboembolic group,with a statistically significant difference(P =0.021,P<0.05).6 The number and proportion of thromboembolic events in the tegretol group was 1 case(7.14%),and the number and proportion of thromboembolic events in the clopidogrel-sensitive group were 6 cases(8.45%),respectively,and the proportion of thromboembolic events in the clopidogrel-sensitive group was significantly higher than that in the tegretol group,with statistically significant differences(P=0.017,P<0.05)The difference between the thromboembolic and non-thromboembolic groups was statistically significant(P<0.05)in terms of diabetes mellitus,hyperuricemia,and aneurysm morphology;after multifactorial logistic regression analysis,the results showed that diabetes mellitus(OR 2.212,95% CI 1.181-4.145;P=0.013),hyperuricemia(OR 1.005,95% CI 1.101-1.219;P=0.015),and ruptured aneurysm(OR1.558,95%CI 1.016-2.548;P=0.044)increase the risk of thromboembolic events after FD therapy,while clopidogrel drug response sensitivity can be considered a protective factor(OR 0.974,95%CI 0.957-0.991;P= 0.003,P<0.005).Conclusions: Antiplatelet drug sensitivity testing is valuable in guiding individualized antiplatelet aggregation dosing and reducing thromboembolic events in postoperative FD patients.