Baseline characteristics of treated aneurysms.

Background and purposeProphylactic prasugrel for endovascular treatment of intracranial aneurysms has been introduced and increased, but HTPR (high on-treatment platelet reactivity) or LTPR (low on-treatment platelet reactivity) of prasugrel is not uncommon in clinical circumstances. To investigate the predisposing factors of HTPR and LTPR on prasugrel premedication in the neurointerventional field and to determine its clinical implications.Materials and methodsBetween February 2016 and December 2020, 191 patients treated with coil embolization using prophylactic prasugrel in 234 intracranial aneurysms were the final candidates for this study. Patient and aneurysm characteristics, clinical status, and laboratory study values were carefully reviewed retrospectively. We performed risk factor analyses for HTPR and LTPR on prasugrel.ResultsUltimately, 20 patients (10.5%) had HTPR, and 74 patients (38.7%) were categorized as having LTPR. In multivariable analyses, the factors related to HTPR were BMI (adjusted OR 1.21, 95% CI 1.04–1.41, p = 0.01), history of antithrombotics (adjusted OR 3.79, 95% CI 1.39–10.34, p = 0.01), and hematocrit (adjusted OR 0.91, 95% CI 0.84–0.99, p = 0.03). Low BMI was the only risk factor for LTPR (adjusted OR 0.84, 95% CI 0.76–0.94, p = 0.001).ConclusionIn the neurointerventional field, high BMI and prior use of antithrombotic agents were related to HTPR, and low BMI was associated with LTPR on prophylactic prasugrel. High hematocrit levels decreased the risk of HTPR. When preparing endovascular treatment for intracranial aneurysms, attention to patients with these clinical features is required to address the possibility of ischemic or bleeding complications.背景与研究目的 颅内动脉瘤血管内治疗的预防性普拉格雷应用已逐渐推广并增多，但临床中普拉格雷所致的治疗中血小板高反应性 (high on-treatment platelet reactivity，HTPR) 与治疗中血小板低反应性 (low on-treatment platelet reactivity，LTPR) 并不少见。本研究旨在探讨神经介入领域中，普拉格雷术前给药时HTPR与LTPR的易感危险因素，并明确其临床意义。 材料与方法 2016年2月至2020年12月期间，共纳入191例接受颅内动脉瘤弹簧圈栓塞术且术中预防性使用普拉格雷的患者（共计234枚颅内动脉瘤）作为本研究的最终研究对象。研究人员对患者及动脉瘤的特征、临床状态及实验室检测指标进行了回顾性详细梳理。针对普拉格雷给药后的HTPR与LTPR开展了危险因素分析。 结果 最终，共计20例患者（占比10.5%）发生HTPR，74例患者（占比38.7%）被归类为LTPR。多因素分析结果显示，与HTPR相关的危险因素包括体质量指数（校正优势比 [adjusted OR] 1.21，95%置信区间 [95% CI] 1.04~1.41，p=0.01）、抗血栓药物用药史（校正OR 3.79，95%CI 1.39~10.34，p=0.01）以及血细胞比容（校正OR 0.91，95%CI 0.84~0.99，p=0.03）。低体质量指数是LTPR的唯一独立危险因素（校正OR 0.84，95%CI 0.76~0.94，p=0.001）。 结论 在神经介入领域中，预防性使用普拉格雷时，高体质量指数与既往抗血栓药物用药史与HTPR相关，而低体质量指数则与LTPR相关；高血细胞比容可降低HTPR的发生风险。在为颅内动脉瘤患者实施血管内治疗术前准备时，需关注具备上述临床特征的患者，以应对缺血或出血并发症的发生可能。