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Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience

PURPOSE: A safe and efficacious antiplatelet drug is needed for patients with clopidogrel resistance who undergo neuroendovascular procedures. Ticagrelor is a new reversibly binding, oral, direct-acting P2Y receptor antagonist with no known resistance. We describe our clinical experience using ticag...

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Autores principales: Karan, Vivek, Vyas, Devashish, Bohra, Vikram, Huded, Vikram
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Interventional Neuroradiology 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736500/
https://www.ncbi.nlm.nih.gov/pubmed/31387163
http://dx.doi.org/10.5469/neuroint.2019.00087
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author Karan, Vivek
Vyas, Devashish
Bohra, Vikram
Huded, Vikram
author_facet Karan, Vivek
Vyas, Devashish
Bohra, Vikram
Huded, Vikram
author_sort Karan, Vivek
collection PubMed
description PURPOSE: A safe and efficacious antiplatelet drug is needed for patients with clopidogrel resistance who undergo neuroendovascular procedures. Ticagrelor is a new reversibly binding, oral, direct-acting P2Y receptor antagonist with no known resistance. We describe our clinical experience using ticagrelor for neuroendovascular procedures in Indian patients with clopidogrel resistance at the NH Institute of Neurosciences, Narayana Health City, Bangalore. MATERIALS AND METHODS: We retrospectively reviewed our endovascular procedure database for all patients with predefined clopidogrel resistance. Clopidogrel resistance was defined as P2Y12 inhibition <40%. Patients were administered ticagrelor along with aspirin prior to the procedure. RESULTS: Of 127 patients, 32 (25%) were non-responders to clopidogrel (22 [69%] males, 10 [31%] females; median age, 54 years [range, 20–75]). All patients were treated with a 180-mg loading dose of ticagrelor, followed by 90 mg twice daily. Twenty patients (63%) underwent endovascular intervention for intracranial aneurysm, two (6%) for dissecting aneurysms, nine (28%) for stenotic lesions, and one (3%) for carotico-cavernous fistula. No patient experienced any adverse effects related to the use of Ticagrelor in the postoperative period. CONCLUSION: Ticagrelor is an effective alternative to clopidogrel for use in conjunction with aspirin in patients with clopidogrel resistance. None of our patients had adverse effects from ticagrelor. Drug cost, twice-daily dosing, and risk of faster platelet aggregation activation after discontinuation should be taken into consideration prior to its use in such patients.
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spelling pubmed-67365002019-09-19 Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience Karan, Vivek Vyas, Devashish Bohra, Vikram Huded, Vikram Neurointervention Original Paper PURPOSE: A safe and efficacious antiplatelet drug is needed for patients with clopidogrel resistance who undergo neuroendovascular procedures. Ticagrelor is a new reversibly binding, oral, direct-acting P2Y receptor antagonist with no known resistance. We describe our clinical experience using ticagrelor for neuroendovascular procedures in Indian patients with clopidogrel resistance at the NH Institute of Neurosciences, Narayana Health City, Bangalore. MATERIALS AND METHODS: We retrospectively reviewed our endovascular procedure database for all patients with predefined clopidogrel resistance. Clopidogrel resistance was defined as P2Y12 inhibition <40%. Patients were administered ticagrelor along with aspirin prior to the procedure. RESULTS: Of 127 patients, 32 (25%) were non-responders to clopidogrel (22 [69%] males, 10 [31%] females; median age, 54 years [range, 20–75]). All patients were treated with a 180-mg loading dose of ticagrelor, followed by 90 mg twice daily. Twenty patients (63%) underwent endovascular intervention for intracranial aneurysm, two (6%) for dissecting aneurysms, nine (28%) for stenotic lesions, and one (3%) for carotico-cavernous fistula. No patient experienced any adverse effects related to the use of Ticagrelor in the postoperative period. CONCLUSION: Ticagrelor is an effective alternative to clopidogrel for use in conjunction with aspirin in patients with clopidogrel resistance. None of our patients had adverse effects from ticagrelor. Drug cost, twice-daily dosing, and risk of faster platelet aggregation activation after discontinuation should be taken into consideration prior to its use in such patients. Korean Society of Interventional Neuroradiology 2019-09 2019-08-07 /pmc/articles/PMC6736500/ /pubmed/31387163 http://dx.doi.org/10.5469/neuroint.2019.00087 Text en Copyright © 2019 Korean Society of Interventional Neuroradiology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Paper
Karan, Vivek
Vyas, Devashish
Bohra, Vikram
Huded, Vikram
Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience
title Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience
title_full Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience
title_fullStr Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience
title_full_unstemmed Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience
title_short Ticagrelor Use in Indian Patients Undergoing Neuroendovascular Procedures: A Single Center Experience
title_sort ticagrelor use in indian patients undergoing neuroendovascular procedures: a single center experience
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736500/
https://www.ncbi.nlm.nih.gov/pubmed/31387163
http://dx.doi.org/10.5469/neuroint.2019.00087
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