Current PRU levels strongly predicted subsequent loss of platelet inhibition during clopidogrel maintenance, with each 10-unit PRU increase raising the odds of future non-response by 18% (OR 1.18).
Observational (n=119)
Does current PRU level predict the loss of therapeutic platelet inhibition during clopidogrel tapering in patients treated for cerebral aneurysms?
A PRU ≥ 210 during clopidogrel tapering identifies patients at high risk of losing therapeutic platelet inhibition after endovascular treatment of cerebral aneurysms.
Effect estimate: OR 1.18
p-value: p=0.0027
Abstract Background and aims Patients undergoing endovascular treatment with flow diverters for intracranial aneurysms require antiplatelet therapy. In hyper-responders, clopidogrel tapering are frequently employed. This study aimed to characterize the evolution of platelet reactivity, measured by P2Y12 Reaction Units (PRU), and to develop a predictive tool to identify patients at risk of loss of therapeutic platelet inhibition (PRU 230) during maintenance. Methods Longitudinal observational study analyzing 1158 PRU determinations from a cohort of hyper-responders (58%; 119 patients; PRU 80) undergoing tapering clopidogrel regimen (from 75 mg to 5 mg maintenance dose). Associations between PRU and covariates (age, sex, diabetes, etc.) were evaluated. A Generalized Estimating Equations (GEE) model was fitted to predict the probability of PRU 230 at the subsequent visit during the maintenance phase (≥ day 23), using current PRU and clopidogrel dose as predictors. Results During the maintenance, the GEE model identified current PRU as a strong predictor of subsequent non-response (p = 0.0027), whereas dose variation was not significant (p = 0.58). Each 10-unit increase in PRU was associated with an 18% increase in the odds of future non-response (OR = 1.18). Using an 8% risk threshold, a PRU ≥ 210 defined a high-risk zone, corresponding to a 9.3–12.5% probability of PRU 230 at the next assessment. Conclusions Current PRU levels are the primary determinant anticipating loss of platelet inhibition during clopidogrel maintenance. The proposed decision rule (alert threshold at PRU ≥ 210) offers a quantitative framework for personalized monitoring and dose adjustment in patients treated for cerebral aneurysms. Conflict of interest Marta Aguilar-Perez: nothing to disclose
Pérez et al. (Fri,) conducted a observational in Intracranial aneurysms (n=119). Clopidogrel tapering was evaluated on Probability of PRU > 230 at the subsequent visit during the maintenance phase (OR 1.18, p=0.0027). Current PRU levels strongly predicted subsequent loss of platelet inhibition during clopidogrel maintenance, with each 10-unit PRU increase raising the odds of future non-response by 18% (OR 1.18).