Low incidence of hemorrhagic complications both during and after surgical procedures in patients maintained on prasugrel single antiplatelet therapy

Ali Khanafer; Alexandru Cimpoca; Paul Bhogal; Oksana Babiy-Pachomow; Peter Kurucz; Oliver Ganslandt; Hans Henkes

doi:10.1016/j.neurad.2022.03.004

Low incidence of hemorrhagic complications both during and after surgical procedures in patients maintained on prasugrel single antiplatelet therapy

J Neuroradiol. 2023 Feb;50(1):65-73. doi: 10.1016/j.neurad.2022.03.004. Epub 2022 Mar 17.

Authors

Ali Khanafer¹, Alexandru Cimpoca², Paul Bhogal³, Oksana Babiy-Pachomow⁴, Peter Kurucz⁵, Oliver Ganslandt⁵, Hans Henkes⁶

Affiliations

¹ Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany. Electronic address: mr-khanafer@hotmail.com.
² Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
³ Department of Interventional Neuroradiology, The Royal London Hospital, London, UK.
⁴ Frauenklinik, Schwerpunkt Gynäkologie, Klinikum Stuttgart, Stuttgart, Germany.
⁵ Neurochirurgische Klinik, Klinikum Stuttgart, Stuttgart, Germany.
⁶ Neuroradiologische Klinik, Klinikum Stuttgart, Stuttgart, Germany; Medical Faculty, Universität Duisburg-Essen, Essen, Germany.

PMID: 35306003
DOI: 10.1016/j.neurad.2022.03.004

Abstract

Background and purpose: Prasugrel (Pra) is a third-generation thienopyridine that inhibits platelet aggregation via irreversible blockade of P2Y12 receptors. While several published studies have examined the use of Pra and acetylsalicylic acid (ASA) in coronary and neurovascular stenting procedures, there is only anecdotal evidence regarding the use of Pra as single antiplatelet therapy (SAPT) in open surgical procedures. This topic has become important because previous studies have revealed that neurovascular devices with antithrombotic coatings can be implanted using non-invasive procedures in patients maintained on Pra SAPT.

Material and methods: Patients who underwent open surgery under Pra SAPT between March 2020 and February 2022 were evaluated retrospectively. Adequate platelet inhibition both before and after the procedures was verified in all patients using Multiplate (Roche Diagnostics) and VerifyNow (Accriva) tests. Intraoperative and postoperative hemorrhagic events were recorded based on reviews of the procedure reports and interviews with the surgeons.

Results: The study enrolled 21 patients who underwent 23 open surgical procedures while maintained on Pra SAPT. The procedures included one extirpation of a brain arteriovenous malformation, seven extra-intracranial bypass surgeries, four ventriculoperitoneal shunts, one eye enucleation for an intractable orbital infection, two gastrostomies, one bone flap reinsertion after craniectomy, one decompressive craniectomy, one case requiring cranial surgical wound care, one colporrhaphy, one transurethral resection of urinary bladder cancer, two tumor oophorectomy/hysterectomy procedures, and one aneurysm clipping. None of the 23 procedures resulted in excessive intraoperative or postoperative hemorrhage.

Conclusion: In a small retrospective series of patients who required antiplatelet therapy for neurovascular indications, Pra SAPT resulted in no significant increase in the incidence of perioperative and postoperative hemorrhagic complications.

Keywords: Antithrombogenic coating; Flow diverter; Hydrophilic coating; P2Y12 receptor inhibition; Prasugrel; Single antiplatelet therapy.

MeSH terms

Aspirin* / adverse effects
Female
Humans
Incidence
Platelet Aggregation Inhibitors* / adverse effects
Prasugrel Hydrochloride / therapeutic use
Retrospective Studies

Substances

Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
Aspirin