Posters
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Medical Student
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Medical Student
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Neurology
Academic Level (Author 2)
Medical Student
Discipline/Specialty (Author 2)
Neurology
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Neurology
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Faculty
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Neurology
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Patients who acutely undergo intra- or extracranial stenting are typically placed on a dual antiplatelet therapy (DAPT) regimen to decrease the risk of in-stent thrombosis. However, initiating these medicines in patients who are already on direct oral anticoagulants (DOACs) is controversial due to the increased risk of hemorrhagic transformation. Studies have been done on patients with atrial fibrillation on DOACs who undergo coronary stenting and subsequently begun on DAPT, but there are no corollaries for patients undergoing acute carotid or intra-cranial stenting and associated safety outcomes. This retrospective cohort study aims to bridge that understanding and checked whether patients with acute ischemic stroke requiring mechanical thrombectomy and acute stenting experienced different rates of adverse outcomes depending on whether they were on triple therapy with DAPT and DOACs or DAPT only.
Methods: A prospectively maintained endovascular database was searched for patients who acutely underwent mechanical thrombectomy and carotid or intra-cranial stenting from 2013 to 2025 at a comprehensive stroke center and were categorized whether they received prior anticoagulation or not. Patient demographics extracted include age, gender, BMI (body mass index), manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admissions NIHSS (National Institute of Health Stroke Scale) scores. Safety and functional outcomes assessed include hemorrhagic transformation, mass effect, mortality, symptomatic and asymptomatic intracranial hemorrhage, and NIHSS and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable.
Results: Of the 186 patients who met inclusion criteria of acutely undergoing MT and stenting, 63 were already on DOACs, 68.25% of whom are male. There was a significant difference in rates of coronary artery disease (33.33% triple therapy cohort vs. 16.67% DAPT-only cohort, p=0.01) and hyperlipidemia (68.25% triple therapy cohort vs. 54.17% DAPT-only cohort , p=0.01); age of patients with mean age±SD of 70.98±11.37 triple therapy cohort vs 65.91±14.163 DAPT-only cohort (p=0.01); and NIHSS scores on admission with median [IQR] scores of 12 [7-17] in the triple therapy cohort group vs. 15 [10-21] in the DAPT-only cohort (p=0.02). None of the measurable safety outcomes displayed any significant differences in the two groups.
Conclusion: Patients who underwent acute mechanical thrombectomy with stenting may be safely started on a triple-therapy regimen if they were already on an anticoagulation therapy regimen prior to their stroke. Our study shows no significant differences in safety and functional outcomes, and supports the elective use of triple therapy in patients requiring acute MT and stenting.
Presentation Type
Poster
Recommended Citation
Monayao, Marlon C.; Garcia Valdez, Kevin; Miller, Samantha; and Hassan, Ameer E., "No Safety Trade-Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy" (2025). Research Colloquium. 65.
https://scholarworks.utrgv.edu/colloquium/2025/posters/65
Included in
No Safety Trade-Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy
Background: Patients who acutely undergo intra- or extracranial stenting are typically placed on a dual antiplatelet therapy (DAPT) regimen to decrease the risk of in-stent thrombosis. However, initiating these medicines in patients who are already on direct oral anticoagulants (DOACs) is controversial due to the increased risk of hemorrhagic transformation. Studies have been done on patients with atrial fibrillation on DOACs who undergo coronary stenting and subsequently begun on DAPT, but there are no corollaries for patients undergoing acute carotid or intra-cranial stenting and associated safety outcomes. This retrospective cohort study aims to bridge that understanding and checked whether patients with acute ischemic stroke requiring mechanical thrombectomy and acute stenting experienced different rates of adverse outcomes depending on whether they were on triple therapy with DAPT and DOACs or DAPT only.
Methods: A prospectively maintained endovascular database was searched for patients who acutely underwent mechanical thrombectomy and carotid or intra-cranial stenting from 2013 to 2025 at a comprehensive stroke center and were categorized whether they received prior anticoagulation or not. Patient demographics extracted include age, gender, BMI (body mass index), manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admissions NIHSS (National Institute of Health Stroke Scale) scores. Safety and functional outcomes assessed include hemorrhagic transformation, mass effect, mortality, symptomatic and asymptomatic intracranial hemorrhage, and NIHSS and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable.
Results: Of the 186 patients who met inclusion criteria of acutely undergoing MT and stenting, 63 were already on DOACs, 68.25% of whom are male. There was a significant difference in rates of coronary artery disease (33.33% triple therapy cohort vs. 16.67% DAPT-only cohort, p=0.01) and hyperlipidemia (68.25% triple therapy cohort vs. 54.17% DAPT-only cohort , p=0.01); age of patients with mean age±SD of 70.98±11.37 triple therapy cohort vs 65.91±14.163 DAPT-only cohort (p=0.01); and NIHSS scores on admission with median [IQR] scores of 12 [7-17] in the triple therapy cohort group vs. 15 [10-21] in the DAPT-only cohort (p=0.02). None of the measurable safety outcomes displayed any significant differences in the two groups.
Conclusion: Patients who underwent acute mechanical thrombectomy with stenting may be safely started on a triple-therapy regimen if they were already on an anticoagulation therapy regimen prior to their stroke. Our study shows no significant differences in safety and functional outcomes, and supports the elective use of triple therapy in patients requiring acute MT and stenting.
