• Casey C May, Devin Holden, Blake T Robbins, Aaron M Cook, Neurocritical Care Society Pharmacy Study Group, Sara Jung, Keaton S Smetana, Christina Roels, Sara Schuman Harlan, Shaun Keegan, Gretchen Brophy, Sulaiman Al Mohaish, Melissa Sandler, Samantha Spetz, Kevin Wohlfarth, Jocelyn Owusu-Guha, Pamela Buschur, Elizabeth Hetrick, Keith Dombrowski, Jennifer Glover, Melissa Levesque, Spencer Dingman, and Mohammed Hussain.
• Department of Pharmacy Practice and Science, The Ohio State University College of Pharmacy, 214A Parks Hall, 500 12th Ave, Columbus, OH, 4321, USA. casey.may@osumc.edu.
• Neurocrit Care. 2024 Feb 1; 40 (1): 262271262-271.

BackgroundDual 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).MethodsThis 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.ResultsFive 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.ConclusionsUsing 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.© 2023. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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