KAROTİD ARTER STENTLEME YAPILAN HASTALARDA KLOPİDOGREL DİRENCİ VE ETKİLEYEN FAKTÖRLERİN DEĞERLENDİRİLMESİ

Year 2024, , 59 - 63, 31.08.2024

İlkin İyigündoğdu , Bengisu Şahin , Eda Derle , Ufuk Can

https://doi.org/10.20492/aeahtd.1426008

Abstract

Amaç:
Karotid arter stentleme yapılan hastalarda peri ve postprosedüral süreçte trombotik komplikasyon riskini azaltmak amacıyla antiaggregan ilaçlar kullanılmaktadır. Hasta tedavi uyumuna rağmen amaçlanan tedavi etkisine ulaşılamayabilir ve bu durum sıklıkla antiagregan direnci ile ilişkilendirilir. Bu çalışmada, karotid arter stentleme yapılan hastalarda klopidogrel direnç sıklığı ve dirençle ilişkili olabilecek risk faktörlerinin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem:
Çalışmada Başkent Üniversitesi Hastanesi’nde 2011-2023 yılları arasında nöroloji klinik yada polikliniklerinde karotid arter stentleme ile takip edilen hastaların verileri retrospektif olarak değerlendirildi. Düzensiz ilaç kullanımı olanlar çalışma dışı bırakıldı. Hastaların demografik özellikleri, aterosklerotik risk faktörleri, semptomları kaydedildi. Takip süreleri, periprosedüral süreçte görülen komplikasyonlar, takip restenoz, işlem sonrası serebrovasküler hastalık ve mortalite oranları saptandı. Stentleme yapılan taraf, darlık derecesi, kontralateral darlık varlığı kaydedildi. Kullanılan antiagregan ilaçlar, kullanım doz ve süreleri, klopidogrel direnç test sonuçları ve test zamanları kaydedildi. Direnç sıklığı ile demografik özellikler, komorbid durumlar, kullanılan ilaçlar ve kan tetkik sonuçları arasında ilişki olup olmadığı araştırıldı. Veriler SPSS paket programı ile analiz edildi. p< 0.05 istatiksel anlamlılık düzeyi olarak kabul edildi.
Bulgular:
Toplam 138 hastanın yaş ortalamaları 68.91±8,66 yıldı ve %71.7’si erkek cinsiyetindeydi. Hastaların %52.2’ sinde sağ karotid arter darlığı bulunmaktaydı. Darlık dereceleri değerlendirildiğinde, 65 hastada (%47.1) ≥ %90 darlık saptandı. 103 hastada (%74.6) semptomatik karotid arter darlığı nedeniyle işlem planlanmıştı. 87 hastada (%63.3) ADP testi yapılmıştı. Klopidogrel kullanan hastaların %17.2’sinde ilaç direnci gözlendi. Klopidogrel direnci kadın hastalarda erkeklere oranla istatiksel olarak anlamlı oranda yüksek saptandı (p<0.05). Yaş, aterosklerotik hastalıkları ve eş zamanlı kullanılan ilaçlar ile klopidogrel direnci arasında istatiksel anlamlı fark saptanmadı. Hastalarda direnç testi bakılma zamanı ile direnç saptanma oranları arasında istatiksel fark izlenmedi.
Sonuç:
Nörovasküler stent hastalarında antiagrean ilaç direncine yönelik veriler yeterli değildir. Bu hastalarda antiagregan ilaç etkisinin ve direncinin belirlenmesi direnç izlenen hasta grubunda stentle ilişkili komplikasyonların ve serebrovasküler olayların önlenmesi için değerli olabilir.

Keywords

karotid arter darlığı, karotid arter stent, klopidogrel direnci

Ethical Statement

BU PROJE BAŞKENT ÜNİVERSİTESİ TIP VE SAĞLIK BİLİMLERİ ARAŞTIRMA KURULU TARAFINDAN ONAYLANMIŞTIR . (PROJE NO : 23/450)

EVALUATION OF CLOPIDOGREL RESISTANCE AND AFFECTING FACTORS IN PATIENTS UNDERGOING CAROTID ARTERY STENTING

Abstract

Aim:
Antiaggregant drugs are used to reduce the risk of thrombotic complications in the peri- and postprocedural period in patients undergoing carotid artery stenting. Despite patient compliance with treatment, the intended treatment effect may not be achieved, and this is often associated with antiaggregant resistance. This study aimed to determine the frequency of clopidogrel resistance and risk factors that may be associated with resistance in patients undergoing carotid artery stenting.
Material and Method:
In the study, the data of patients who were followed up with carotid artery stenting in neurology clinics or outpatient clinics at Başkent University Hospital between 2011 and 2023 were evaluated retrospectively. Those who used irregular medication were excluded from the study. The demographic characteristics, atherosclerotic risk factors, and symptoms of the patients were recorded. Follow-up periods, periprocedural complications, follow-up restenosis, post-procedural cerebrovascular disease and mortality rates were determined. The side of stenting, the degree of stenosis, and the presence of contralateral stenosis were recorded. Antiaggregant drugs used, dosage and duration of use, clopidogrel resistance test results and test times were recorded. The relationship between the frequency of resistance and demographic characteristics, comorbid conditions, medications used and blood test results were evaluated. The data were analyzed with the SPSS program. p< 0.05 was accepted as the level of statistical significance.
Results:
The average age of a total of 138 patients was 68.91±8.66 years and 71.7% were male. 52.2% of the patients had right carotid artery stenosis. ≥ 90% stenosis was detected in 65 patients (47.1%). The procedure was planned in 103 patients (74.6%) due to symptomatic carotid artery stenosis. ADP test was performed in 87 patients (63.3%). Drug resistance was observed in 17.2% of patients using clopidogrel. Clopidogrel resistance was found to be statistically significantly higher in female patients than in males (p<0.05). No statistically significant difference was found between age, atherosclerotic diseases, concurrent medications and clopidogrel resistance. No statistical difference was observed between the time of testing and the resistance detection rates in the patients.
Conclusion:
There are insufficient data on antiplatelet drug resistance in neurovascular stent patients. Determining the antiplatelet drug effect and resistance in these patients may be valuable to prevent stent-related complications and cerebrovascular events in the patient group with resistance.

Keywords

carotid artery stenosis, carotid artery stent, clopidogrel resistance

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