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Preliminary Experience of Preoperative Modification of Platelet Aggregation

Objective: Antiplatelet drugs are frequently used to prevent ischemic complications of endovascular therapy, but patients who showed poor responses to these drugs have been reported. We have adjusted antiplatelet drugs based on platelet aggregation activity before endovascular therapy. The objective of this study was to investigate the association between platelet aggregation test-based modification of antiplatelet drugs and perioperative complications. Methods: In this study, we enrolled 146 patients who received elective endovascular therapy between October 2015 and December 2016. All patients received administration of aspirin 100 mg and clopidogrel 75 mg from 2 weeks before endovascular therapy and platelet aggregation activity was measured 1–2 days before the procedure. Cilostazol was additionally administered to patients who poorly responded to aspirin, or the drug was switched to prasugrel in patients who poorly responded to clopidogrel. Thereafter, platelet aggregation activity was re-tested on the following morning. Results: On the initial test, 52 (35.6%) and 57 (39.0%) patients showed poor responses to aspirin and clopidogrel, respectively, and these rates were higher than those previously reported. After antiplatelet drug modification, 31 (21.2%) and 20 (13.7%) patients showed poor responses to aspirin and clopidogrel, respectively, showing significant decreases (p = 0.012 and <0.0001, respectively). Perioperative ischemic complication developed in five patients (3.4%), being lower than that (4.6%) previously reported. Conclusion: The rate of patients with poor responses to antiplatelet drugs on the platelet aggregation test was higher than those previously reported, but their responses were improved by drug modification. Platelet aggregation test-based drug modification may be effective to prevent perioperative complications and further investigation is necessary.