Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents

Casey C. May; Devin Holden; Blake T. Robbins; Aaron M. Cook; Sara Jung; Keaton S. Smetana; Christina Roels; Sara Schuman Harlan; Shaun Keegan; Gretchen Brophy; Sulaiman Al Mohaish; Melissa Sandler; Samantha Spetz; Kevin Wohlfarth; Jocelyn Owusu-Guha; Pamela Buschur; Elizabeth Hetrick; Keith Dombrowski; Jennifer Glover; Melissa Levesque; Spencer Dingman; Mohammed Hussain

doi:10.1007/s12028-023-01749-7

Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents

Casey C. May
, Devin Holden
, Blake T. Robbins
, Aaron M. Cook
, Sara Jung
, Keaton S. Smetana
, Christina Roels
, Sara Schuman Harlan
, Shaun Keegan
, Gretchen Brophy
, Sulaiman Al Mohaish
, Melissa Sandler
, Samantha Spetz
, Kevin Wohlfarth
, Jocelyn Owusu-Guha
, Pamela Buschur
, Elizabeth Hetrick
, Keith Dombrowski
, Jennifer Glover
, Melissa Levesque

Spencer Dingman, Mohammed Hussain

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Background: Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T). Methods: This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3–6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3–6 months after the procedure. Results: Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p = 0.97) and no difference in any of the secondary safety outcomes. Conclusions: Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.

Original language	English
Pages (from-to)	262-271
Number of pages	10
Journal	Neurocritical Care
Volume	40
Issue number	1
DOIs	https://doi.org/10.1007/s12028-023-01749-7
State	Published - Feb 2024

Bibliographical note

Publisher Copyright:
© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2023.

Funding

Neurocritical Care Society Pharmacy Study Group: Sara Jung4, PharmD, MS, BCCCP (Wellstar Kennestone Hospital, Marietta, GA, USA). Keaton S. Smetana5, PharmD, MBA, BCCCP (The Ohio State Wexner Medical Center, Columbus, OH, USA). Christina Roels6, PharmD, CPP, BCPS, BCCCP (Novant Health Forsyth Medical Center, Winston-Salem, NC, USA). Sara Schuman Harlan7, PharmD, BCCCP (University of Cincinnati Medical Center, Cincinnati, OH, USA). Shaun Keegan7, PharmD, BCPS (University of Cincinnati Medical Center, Cincinnati, OH, USA). Gretchen Brophy8, PharmD, BCPS, FCCP, FCCM, FNCS, MCCM (Virginia Commonwealth University, Richmond, VA, USA). Sulaiman Al Mohaish8, PharmD, BCPS (Virginia Commonwealth University, Richmond, VA, USA). Melissa Sandler8, PharmD, BCCCP (Virginia Commonwealth University, Richmond, VA, USA). Samantha Spetz9, PharmD, BCCCP (ProMedica Toledo Hospital, Toledo, OH, USA). Kevin Wohlfarth9, PharmD, BCPS, BCCCP, BCCP (ProMedica Toledo Hospital, Toledo, OH, USA). Jocelyn Owusu-Guha10, PharmD (OhioHealth Riverside Methodist Hospital, Columbus, OH, USA). Pamela Buschur10, PharmD, BCPS (OhioHealth Riverside Methodist Hospital, Columbus, OH, USA). Elizabeth Hetrick11, PharmD, BCPS, BCCCP (Tacoma General Hospital MultiCare Health System, Tacoma, WA, USA). Keith Dombrowski12, MD (University of South Florida/Tampa General Hospital, Tampa, FL, USA). Jennifer Glover12, MD, FACS (University of South Florida/Tampa General Hospital, Tampa, FL, USA). Melissa Levesque12, PharmD, BCPS, BCCCP (University of South Florida/Tampa General Hospital, Tampa, FL, USA). Spencer Dingman13, PharmD, BCCCP (Wesley Medical Center, Wichita, KS, USA). Mohammed Hussain13, MD (Wesley Medical Center, Wichita, KS, USA).

Funders
BCPS
FACS
FCCM
FCCP
FNCS
MCCM
OhioHealth Riverside Methodist Hospital
ProMedica Toledo Hospital
University of Cincinnati Medical Center
University of South Florida/Tampa General Hospital
Wesley Medical Center
Virginia Commonwealth University
Massachusetts Broadcasters Association

Keywords

Carotid artery diseases
Carotid stenosis
Clopidogrel
Dual antiplatelet therapy
Intracranial aneurysm
Ticagrelor

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Clinical Neurology

Access to Document

10.1007/s12028-023-01749-7

Cite this

May, C. C., Holden, D., Robbins, B. T., Cook, A. M., Jung, S., Smetana, K. S., Roels, C., Harlan, S. S., Keegan, S., Brophy, G., Al Mohaish, S., Sandler, M., Spetz, S., Wohlfarth, K., Owusu-Guha, J., Buschur, P., Hetrick, E., Dombrowski, K., Glover, J., ... Hussain, M. (2024). Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents. Neurocritical Care, 40(1), 262-271. https://doi.org/10.1007/s12028-023-01749-7

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title = "Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents",

abstract = "Background: Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T). Methods: This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3–6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3–6 months after the procedure. Results: Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8\% vs. 8\%, p = 0.97) and no difference in any of the secondary safety outcomes. Conclusions: Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.",

keywords = "Carotid artery diseases, Carotid stenosis, Clopidogrel, Dual antiplatelet therapy, Intracranial aneurysm, Ticagrelor",

author = "May, \{Casey C.\} and Devin Holden and Robbins, \{Blake T.\} and Cook, \{Aaron M.\} and Sara Jung and Smetana, \{Keaton S.\} and Christina Roels and Harlan, \{Sara Schuman\} and Shaun Keegan and Gretchen Brophy and \{Al Mohaish\}, Sulaiman and Melissa Sandler and Samantha Spetz and Kevin Wohlfarth and Jocelyn Owusu-Guha and Pamela Buschur and Elizabeth Hetrick and Keith Dombrowski and Jennifer Glover and Melissa Levesque and Spencer Dingman and Mohammed Hussain",

note = "Publisher Copyright: {\textcopyright} Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2023.",

year = "2024",

month = feb,

doi = "10.1007/s12028-023-01749-7",

language = "English",

volume = "40",

pages = "262--271",

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May, CC, Holden, D, Robbins, BT, Cook, AM, Jung, S, Smetana, KS, Roels, C, Harlan, SS, Keegan, S, Brophy, G, Al Mohaish, S, Sandler, M, Spetz, S, Wohlfarth, K, Owusu-Guha, J, Buschur, P, Hetrick, E, Dombrowski, K, Glover, J, Levesque, M, Dingman, S & Hussain, M 2024, 'Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents', Neurocritical Care, vol. 40, no. 1, pp. 262-271. https://doi.org/10.1007/s12028-023-01749-7

TY - JOUR

T1 - Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents

AU - May, Casey C.

AU - Holden, Devin

AU - Robbins, Blake T.

AU - Cook, Aaron M.

AU - Jung, Sara

AU - Smetana, Keaton S.

AU - Roels, Christina

AU - Harlan, Sara Schuman

AU - Keegan, Shaun

AU - Brophy, Gretchen

AU - Al Mohaish, Sulaiman

AU - Sandler, Melissa

AU - Spetz, Samantha

AU - Wohlfarth, Kevin

AU - Owusu-Guha, Jocelyn

AU - Buschur, Pamela

AU - Hetrick, Elizabeth

AU - Dombrowski, Keith

AU - Glover, Jennifer

AU - Levesque, Melissa

AU - Dingman, Spencer

AU - Hussain, Mohammed

N1 - Publisher Copyright: © Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2023.

PY - 2024/2

Y1 - 2024/2

N2 - Background: Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T). Methods: This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3–6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3–6 months after the procedure. Results: Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p = 0.97) and no difference in any of the secondary safety outcomes. Conclusions: Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.

AB - Background: Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T). Methods: This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3–6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3–6 months after the procedure. Results: Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p = 0.97) and no difference in any of the secondary safety outcomes. Conclusions: Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.

KW - Carotid artery diseases

KW - Carotid stenosis

KW - Clopidogrel

KW - Dual antiplatelet therapy

KW - Intracranial aneurysm

KW - Ticagrelor

UR - https://www.scopus.com/pages/publications/85161942159

UR - https://www.scopus.com/pages/publications/85161942159#tab=citedBy

U2 - 10.1007/s12028-023-01749-7

DO - 10.1007/s12028-023-01749-7

M3 - Article

C2 - 37322326

AN - SCOPUS:85161942159

SN - 1541-6933

VL - 40

SP - 262

EP - 271

JO - Neurocritical Care

JF - Neurocritical Care

IS - 1

ER -

Multicenter Comparison of the Safety and Efficacy of Clopidogrel Versus Ticagrelor for Neuroendovascular Stents

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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