May Casey C, Holden Devin, Robbins Blake T, Cook Aaron M, Jung Sara, Smetana Keaton S, Roels Christina, Harlan Sara Schuman, Keegan Shaun, Brophy Gretchen, Al Mohaish Sulaiman, Sandler Melissa, Spetz Samantha, Wohlfarth Kevin, Owusu-Guha Jocelyn, Buschur Pamela, Hetrick Elizabeth, Dombrowski Keith, Glover Jennifer, Levesque Melissa, Dingman Spencer, Hussain Mohammed
Department of Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 214A Parks Hall, 500 12th Ave, Columbus, OH, 4321, USA.
Department of Pharmacy, Albany Medical Center, Albany, NY, USA.
Neurocrit Care. 2024 Feb;40(1):262-271. doi: 10.1007/s12028-023-01749-7. Epub 2023 Jun 15.
Dual antiplatelet therapy (DAPT) is commonly employed for neuroendovascular stenting due to the significant risk of thromboembolism. Clopidogrel and aspirin are most often selected as initial DAPTs; however, there is limited literature available to support guidance of DAPT in this setting. The objective of this study was to evaluate safety and efficacy in patients whose final regimen included either DAPT with aspirin and clopidogrel (DAPT-C) or DAPT with aspirin and ticagrelor (DAPT-T).
This was a multicenter, retrospective cohort of patients who underwent neuroendovascular stenting and received DAPT between July 1, 2017, and October 31, 2020. Study participants were allocated into groups based on discharge DAPT regimen. The primary outcome was incidence of stent thrombosis at 3-6 months on DAPT-C versus DAPT-T, as defined by the presence of thrombus on imaging or new onset stroke. Secondary outcomes included major and minor bleeding and death within 3-6 months after the procedure.
Five hundred and seventy patients were screened across 12 sites. Of those, 486 were included (DAPT-C n = 360, DAPT-T n = 126). There was no difference in the primary outcome of stent thrombosis between the DAPT-C and DAPT-T groups (8% vs. 8%, p = 0.97) and no difference in any of the secondary safety outcomes.
Using DAPT-C or DAPT-T regimens in a broad population of neuroendovascular stenting procedures appears to have similar safety and efficacy profiles. Further prospective evaluation is warranted to streamline the practice of DAPT selection and monitoring to determine the impact on clinical outcomes.
由于存在显著的血栓栓塞风险，双重抗血小板治疗（DAPT）常用于神经血管内支架置入术。氯吡格雷和阿司匹林最常被选为初始DAPT药物；然而，在这种情况下，支持DAPT指导的文献有限。本研究的目的是评估最终治疗方案为阿司匹林联合氯吡格雷的DAPT（DAPT-C）或阿司匹林联合替格瑞洛的DAPT（DAPT-T）的患者的安全性和有效性。
这是一项多中心回顾性队列研究，研究对象为2017年7月1日至2020年10月31日期间接受神经血管内支架置入术并接受DAPT治疗的患者。研究参与者根据出院时的DAPT治疗方案分组。主要结局是DAPT-C组与DAPT-T组在3至6个月时支架血栓形成的发生率，通过影像学上血栓的存在或新发卒中定义。次要结局包括术后3至6个月内的严重和轻微出血以及死亡。
在12个地点筛查了570名患者。其中，486名患者被纳入研究（DAPT-C组n = 360，DAPT-T组n =
126）。DAPT-C组和DAPT-T组在支架血栓形成的主要结局方面没有差异（8%对8%，p = 0.97），在任何次要安全结局方面也没有差异。
在广泛的神经血管内支架置入术患者中使用DAPT-C或DAPT-T方案似乎具有相似的安全性和有效性。有必要进行进一步的前瞻性评估，以简化DAPT选择和监测的实践，以确定对临床结局的影响。
