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The related main theme: A. Stroke and Cerebral vascular disorders


Antiplatelet Medication for Endovascular Treatment in Patients with Clopidogrel Resistance: a Network Meta-analysis


翁旭惠, PhD, MD 1 , 蔡元雄, PhD, MD 1 , 張勝為, MD 1 , 陳俊儒, MD 1 , 
Hsu-Huei  Weng, PhD, MD 1 , Yuan-Hsiung  Tsai, PhD, MD 1 , Shen-Wei   Chang, MD 1 , Chun-Ju  Chen, MD 1 , 
1 嘉義長庚紀念醫院暨長庚大學 放射診斷科
1 Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taoyuan, Taiwan
Corresponding Author:

Hsu-Huei  Weng , PhD, MD
嘉義長庚紀念醫院暨長庚大學 放射診斷科
Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Chiayi, Taiwan

keywords: endovascular, antiplatelet, clopidogrel, network meta-analysis
Abstract for original article

Patients undergoing neuroendovascular procedures are often medicated with antiplatelet agents to prevent complications. The combination of aspirin and clopidogrel is often prescribed in modern practices. However, patients with clopidogrel hyporesponders are more likely to shift to use alternative P2Y12 inhibitors such as prasugrel and ticagrelor. We aimed to investigate the efficacy and safety of different antiplatelet strategies in clopidogrel resistant patients undergoing neuroendovascular therapy using network meta-analyses.

PubMed and related databases were searched for articles published between January 2000 and October 2019. Studies included all research reporting the efficacy and safety of different antithrombotic strategies by odds ratio (OR). Findings between 4 regimens (clopidogrel, low-dose prasugrel, high-dose prasugrel, and ticagrelor) were analyzed with ORs of complication with standard statistical procedures.

Seven articles and studies met inclusion criteria. Among 4 regimens, low-dose prasugrel had the lowest OR when comparing to clopidogrel [0.348, 95% CI (0.106, 1.151)], high-dose prasugrel [0.196, 95% CI (0.034, 1.115)], and ticagrelor [0.551, 95% CI, (0.090, 3.389)], respectively. Within-study bias and heterogeneity were low in all included analyses.

Based on this network meta-analysis, low-dose prasugrel could be the possible choice of complication prevention among the neuroendovascular procedures.