Low incidence of hemorrhagic complications both during and after surgical procedures in patients maintained on prasugrel single antiplatelet therapy

Background and purpose: Prasugrel (Pra) is a third-generation thienopyridine that inhibits platelet aggrega-tion via irreversible blockade of P2Y12 receptors. While several published studies have examined the use of Pra and acetylsalicylic acid (ASA) in coronary and neurovascular stenting procedures, there is only anecdotal evidence regarding the use of Pra as single antiplatelet therapy (SAPT) in open surgical procedures. This topic has become important because previous studies have revealed that neurovascular devices with antithrom-botic coatings can be implanted using non-invasive procedures in patients maintained on Pra SAPT. Material and methods: Patients who underwent open surgery under Pra SAPT between March 2020 and Feb-ruary 2022 were evaluated retrospectively. Adequate platelet inhibition both before and after the procedures was verified in all patients using Multiplate (Roche Diagnostics) and VerifyNow (Accriva) tests. Intraoperative and postoperative hemorrhagic events were recorded based on reviews of the procedure reports and inter-views with the surgeons. Results: The study enrolled 21 patients who underwent 23 open surgical procedures while maintained on Pra SAPT. The procedures included one extirpation of a brain arteriovenous malformation, seven extra-intracra-nial bypass surgeries, four ventriculoperitoneal shunts, one eye enucleation for an intractable orbital infec-tion, two gastrostomies, one bone flap reinsertion after craniectomy, one decompressive craniectomy, one case requiring cranial surgical wound care, one colporrhaphy, one transurethral resection of urinary bladder cancer, two tumor oophorectomy/hysterectomy procedures, and one aneurysm clipping. None of the 23 pro-cedures resulted in excessive intraoperative or postoperative hemorrhage. Conclusion: In a small retrospective series of patients who required antiplatelet therapy for neurovascular indications, Pra SAPT resulted in no significant increase in the incidence of perioperative and postoperative hemorrhagic complications. (c) 2022 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Automated summary

This study retrospectively evaluated the use of Prasugrel as single antiplatelet therapy in open surgical procedures and found that it did not lead to excessive intraoperative and postoperative hemorrhage in neurovascular surgeries.