Antiplatelet Agents and Platelet Function Assays

Antiplatelet agents are commonly used in patients undergoing neuroendovascular procedures to protect stent deployment and reduce cardiovascular risk. Aspirin is usually combined with a P2Y12 inhibitor for dual antiplatelet therapy, and the selection of the P2Y12 inhibitor is often driven by the risk of thrombosis and patient-specific factors. Platelet function testing is available to predict response, particularly in patients receiving clopidogrel, which exhibits substantial pharmacogenetic variability in activity. Antiplatelet therapy can also complicate acute intracranial bleeding and may merit abrupt reversal to mitigate hematoma expansion. Patient selection and the optimal strategy for reversal are typically a case-by-case basis depending on the severity of bleeding and the antiplatelet agent used.