Assessing a 600-mg Loading Dose of Clopidogrel 24 Hours Prior to Pipeline Embolization Device Treatment

Authors

Elias Atallah, MD, Thomas Jefferson UniversityFollow
Hassan Saad, MD, Thomas Jefferson UniversityFollow
Kimon Bekelis, MD, Thomas Jefferson UniversityFollow
Nohra Chalouhi, MD, Thomas Jefferson UniversityFollow
Stavropoula Tjoumakaris, MD, Thomas Jefferson UniversityFollow
David Hasan, MD, Thomas Jefferson UniversityFollow
Hekmat Zarzour, MD, Thomas Jefferson UniversityFollow
Michelle Smith, MD, Thomas Jefferson University
Robert H. Rosenwasser, MD, MBA, FACS, FAHA, Thomas Jefferson UniversityFollow
Pascal Jabbour MD, Thomas Jefferson UniversityFollow

Abstract

Background:

Clopidogrel/aspirin antiplatelet therapy routinely is administered 7-10 days before pipeline aneurysm treatment. Our study assessed the safety and efficacy of a 600-mg loading dose of clopidogrel 24 hours before Pipeline Embolization Device (PED) treatment.

Methods: In this retrospective cohort study, we included patients treated with PED from October 2010 to May 2016. A total of 39.7% (n = 158) of patients were dispensed a loading dose of 650 mg of aspirin plus at least 600 mg of clopidogrel 24 hours preceding PED deployment, compared to 60.3% (n = 240) of patients who received 81-325 mg of aspirin daily for 10 days with 75 mg of clopidogrel daily preprocedurally. The mean follow-up was 15.8 months (standard deviation [SD] 12.4 months). modified Rankin Scale (mRS) was registered before the discharge and at each follow-up visit. To control confounding, we used multivariable logistic regression and propensity score conditioning.

Results: Of 398 patients, the proportion of female patients was ~16.5% (41/240) in both groups and shared the same mean of age ~56.46 years. ~12.2% (mean = 0.09; SD = 0.30) had a subarachnoid hemorrhage. 92% (mean = 0.29; SD = 0.70) from the pretreatment group and 85.7% (mean = 0.44; SD = 0.91) of the bolus group had a mRS ≤2. In multivariate analysis, bolus did not affect the mRS score, P = 0.24. Seven patients had a long-term recurrence, 2 (0.83%; mean = 0.01; SD = 0.10) of which from the pretreatment group. In a multivariable logistic regression, bolus was not associated with a long-term recurrence rate (odds ratio [OR] 1.91; 95% confidence interval [CI] 0.27-13.50; P = 0.52) or with thromboembolic accidents (OR 0.99; 95% CI 0.96-1.03; P = 0.83) nor with hemorrhagic events (OR 1.00; 95% CI 0.97-1.03; P = 0.99). Three patients died: one who received a bolus had an acute subarachnoid hemorrhage. The mean mortality rate was parallel in both groups ~0.25 (SD = 0.16). Bolus was not associated with mortality (OR 1.11; 95% CI 0.26-4.65; P = 0.89). The same associations were present in propensity score-adjusted models.

Conclusions: In a cohort receiving PED, a 600-mg loading dose of clopidogrel should be safe and efficacious in those off the standard protocol or showing <30% platelet inhibition before treatment.

Recommended Citation

Atallah, MD, Elias; Saad, MD, Hassan; Bekelis, MD, Kimon; Chalouhi, MD, Nohra; Tjoumakaris, MD, Stavropoula; Hasan, MD, David; Zarzour, MD, Hekmat; Smith, MD, Michelle; Rosenwasser, MD, MBA, FACS, FAHA, Robert H.; and Jabbour, Pascal MD (2018) "Assessing a 600-mg Loading Dose of Clopidogrel 24 Hours Prior to Pipeline Embolization Device Treatment," JHN Journal: Vol. 13: Iss. 2, Article 2.
DOI: https://doi.org/10.29046/JHNJ.013.2.002
Available at: https://jdc.jefferson.edu/jhnj/vol13/iss2/2