Low-Dose Prasugrel vs Clopidogrel-Based Tailored Premedication for Endovascular Treatment of Cerebral Aneurysms

Neurosurgery. 2019 Jul 1;85(1):E52-E59. doi: 10.1093/neuros/nyy341.


Background: Antiplatelet premedication is widely accepted for interventional treatment of cerebral aneurysms to prevent thromboembolism. However, antiplatelet resistance sometimes limits the effectiveness of premedication.

Objective: To compare 2 groups administered low-dose prasugrel (PSG group) or clopidogrel-based tailored antiplatelet (CPG group) in terms of platelet function and procedure-related complications.

Methods: A total of 411 patients with 505 unruptured aneurysms who underwent endovascular treatment within the past 17 mo were retrospectively enrolled in this study. The PSG (225 patients with 277 aneurysms) and CPG groups (186 patients with 228 aneurysms) were administered the respective medication prior to endovascular treatment. We measure the response to the antiplatelet medication with a laboratory test. Episodes of periprocedural bleeding and thromboembolism were compared between the 2 groups.

Results: There were significant differences between the 2 groups in terms of the mean P2Y12 reaction unit values (125.7 in the PSG group vs 251.0 in the CPG group; P < .001) and percentage inhibition (57.8% vs 18.7%, respectively; P < .001). Drug resistance was 29.6% per patient in the CPG group and 2.7% per patient in the PSG group. The PSG group reported 1 thromboembolism and bleeding each; meanwhile, the CPG group reported 7 thromboembolism and 3 bleeding. Compared to clopidogrel administration, prasugrel administration significantly decreased the risk of thromboembolism (weighted hazard ratio, 0.17; 95% confidence interval, 0.03-0.99). However, the risk of bleeding was not significant.

Conclusion: Prasugrel was found to be more effective in reducing periprocedural thromboembolism compared to clopidogrel.

Keywords: Cerebral aneurysms; Clopidogrel; Endovascular treatment; Prasugrel; Thromboembolism.

MeSH terms

  • Aged
  • Clopidogrel / therapeutic use*
  • Endovascular Procedures / adverse effects
  • Female
  • Humans
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Prasugrel Hydrochloride / therapeutic use*
  • Premedication / methods
  • Retrospective Studies
  • Thromboembolism / etiology
  • Thromboembolism / prevention & control*


  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Prasugrel Hydrochloride