Introduction: Dual antiplatelet therapy (DAPT) is commonly utilized after neuroendovascular stenting to prevent thromboembolism. More literature has been published supporting the use of ticagrelor in this setting; however, literature regarding platelet function testing (PFT) guided dosing of ticagrelor is limited. The objective of this study was to evaluate the PFT-guided dosing of ticagrelor post neuroendovascular stenting.
Methods: Patients who were underwent neuroendovascular stenting at a single center between January 2015 and August 2023 and received any dose of DAPT with ticagrelor (DAPT-T) and at least one PFT to guide dosing were included. Data regarding patient demographics, procedure details, DAPT-T dosing, PFT results, and thromboembolic and bleeding complications were collected. The overall rate of bleeding and thrombotic complications in the entire cohort was analyzed because all patients had PFT utilized to assess dosing. In addition, patients were divided into different dosing groups based on dose received to assess the relative safety and efficacy of different ticagrelor doses. The primary and secondary outcomes of stent thrombosis or new onset stroke and bleeding complications within six months post-stenting were compared between the ticagrelor dosing groups.
Results: Two hundred and ninety-six patients were screened and 198 were included. A total of 18 (9%) thrombotic events occurred and 15 (8%) bleeding event occurred in the entire cohort. Patient were divided into three cohorts for ticagrelor dose analysis: standard (T-S; n= 46), these patients received 90 mg BID dosing; reduced dose (T-RD; n=94), these patients received 60 mg BID dosing; dose changed (T-DC; n=58), these patient’s doses were changed during their course of treatment based on PFT results. Overall, there was no statistically significant difference in the primary outcome of thrombotic events (T-S cohort: 9% vs T-RD: 7% vs T-DC: 12%; p=0.63) or in bleeding complications (T-S cohort: 7% vs T-RD: 9% vs T-DC: 7%; p=1.0) between the different ticagrelor dosing regimens.
Conclusions: Utilizing PFT to guide dosing of ticagrelor in neuroendovascular patients post stenting showed low thrombotic and bleeding events; in addition, there was no difference in thrombotic and bleeding outcomes based on ticagrelor dose received.
