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<meta name="DC.Title" content="Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4411" />
<meta name="DC.Date" content="2015-11-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2015 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes.

MATERIALS AND METHODS: Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ2 test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume.

RESULTS: Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; P = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; P &lt; .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; P = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; P = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10–9.61]; P = .03).

CONCLUSIONS: Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.

PED
:   Pipeline embolization device" />
<meta name="DC.Contributor" content="W. Brinjikji" />
<meta name="DC.Contributor" content="G. Lanzino" />
<meta name="DC.Contributor" content="H.J. Cloft" />
<meta name="DC.Contributor" content="A.H. Siddiqui" />
<meta name="DC.Contributor" content="R.A. Hanel" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="article:published_time" content="2015-11-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ&lt;sup&gt;2&lt;/sup&gt; test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; &lt;i&gt;P&lt;/i&gt; = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; &lt;i&gt;P&lt;/i&gt; &amp;lt; .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; &lt;i&gt;P&lt;/i&gt; = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; &lt;i&gt;P&lt;/i&gt; = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10–9.61]; &lt;i&gt;P&lt;/i&gt; = .03).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2015/11/01" />
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<meta name="citation_author" content="W. Brinjikji" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)" />
<meta name="citation_author" content="G. Lanzino" />
<meta name="citation_author_institution" content="aFrom the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)" />
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<meta name="twitter:title" content="Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes.

MATERIALS AND METHODS: Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ2 test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume.

RESULTS: Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; P = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; P &lt; .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; P = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; P = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10–9.61]; P = .03).

CONCLUSIONS: Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.

PED
:   Pipeline embolization device" />
<meta name="og-title" property="og:title" content="Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/36/11/2090" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes.

MATERIALS AND METHODS: Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ2 test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume.

RESULTS: Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; P = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; P &lt; .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; P = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; P = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10–9.61]; P = .03).

CONCLUSIONS: Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.

PED
:   Pipeline embolization device" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Platelet Testing is Associated with Worse Clinical Outcomes for Patients Treated with the Pipeline Embolization Device</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">W. Brinjikji</span>, <span class="highwire-citation-author" data-delta="1">G. Lanzino</span>, <span class="highwire-citation-author" data-delta="2">H.J. Cloft</span>, <span class="highwire-citation-author" data-delta="3">A.H. Siddiqui</span>, <span class="highwire-citation-author" data-delta="4">R.A. Hanel</span> and <span class="highwire-citation-author" data-delta="5">D.F. Kallmes</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">November 2015,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2090-2095; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4411 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14228--6176641903" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">W. Brinjikji </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.%2BBrinjikji%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brinjikji%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AW.%2BBrinjikji%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">G. Lanzino </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BLanzino%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lanzino%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BLanzino%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">H.J. Cloft </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.J.%2BCloft%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cloft%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.J.%2BCloft%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A.H. Siddiqui </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurosurgery (A.H.S.), State University of New York, Buffalo, New York</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.H.%2BSiddiqui%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Siddiqui%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA.H.%2BSiddiqui%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">R.A. Hanel </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Neurosurgery (R.A.H.), Baptist Neurological Institute, Jacksonville, Florida.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.A.%2BHanel%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hanel%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AR.A.%2BHanel%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">D.F. Kallmes </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Radiology (W.B., G.L., H.J.C., D.F.K.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery (G.L., H.J.C., D.F.K.), Mayo Clinic, Rochester, Minnesota</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.F.%2BKallmes%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kallmes%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.F.%2BKallmes%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> The necessity for platelet-inhibition testing before aneurysm treatment in patients premedicated with antiplatelet agents is controversial. Using the International Retrospective Study of Pipeline Embolization Device registry, we studied complication rates in groups of patients who underwent platelet testing and those who did not undergo platelet testing to determine if these test results were associated with improved outcomes.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> Patients in the International Retrospective Study of Pipeline Embolization Device registry with an unruptured aneurysm were categorized as those who underwent platelet testing before Pipeline embolization device treatment or those who did not. Complication rates were compared by using the Fisher exact or Pearson χ<sup>2</sup> test. Multivariate analysis was performed to determine if platelet function testing was independently associated with poor outcomes after adjusting for age, number of devices and aneurysms, aneurysm location and size, and practitioner and center volume.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> Compared with the patients who received a Pipeline embolization device without platelet testing, those who underwent platelet testing and Pipeline embolization device placement experienced higher rates of intracranial hemorrhage (0 of 187 [0.0%] vs 12 of 511 [2.3%], respectively; <em>P</em> = .04), neurologic morbidity (4 of 187 [2.1%] vs 42 of 511 [8.2%], respectively; <em>P</em> &lt; .01), and combined neurologic morbidity and mortality (6 of 187 [3.2%] vs 45 of 511 [8.8%], respectively; <em>P</em> = .01). More patients in the platelet testing and Pipeline embolization device group were treated with multiple devices (227 [38.0%] vs 56 [27.8] patients, respectively; <em>P</em> = .01). On multivariate analysis, the group of patients who underwent platelet testing and Pipeline embolization device placement had higher odds of neurologic morbidity (OR, 3.25 [95% CI, 1.10–9.61]; <em>P</em> = .03).</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Platelet testing in patients who undergo Pipeline embolization device placement is associated with higher rates of morbidity. Additional prospective studies are needed to determine if and when platelet testing in these patients is appropriate.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATION:</h2><dl id="def-list-1"><dt id="def-item-1">PED<span class="def-item-dt-sep"></span></dt><dd>Pipeline embolization device</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2015 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/36/11/2090.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 36</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 11 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Nov 2015 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Brinjikji</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Lanzino</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">H.J.</span> <span class="nlm-surname">Cloft</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">A.H.</span> <span class="nlm-surname">Siddiqui</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">R.A.</span> <span class="nlm-surname">Hanel</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Nov 2015, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(11) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">2090-2095; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4411 </span></div>
  
  
  
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