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Published on: November 8, 2024
Ticagrelor Versus Clopidogrel as Dual Antiplatelet Agents After Flow Diversion With Surface-Modified Stents
Joanna M Roy1, Basel Musmar1, Mary-Katharine Pontarelli1
1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Insights
Dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel showed similar safety and effectiveness after flow diversion. Clopidogrel is recommended first-line for preventing ischemic events, with ticagrelor as a safe alternative if resistance occurs.
Area of Science:
- Cardiovascular Medicine
- Interventional Neurology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is crucial post-flow diversion.
- No prior studies compared ticagrelor vs. clopidogrel DAPT with newer stents.
- This study addresses this gap in knowledge.
Purpose of the Study:
- To compare the safety and efficacy of ticagrelor-based DAPT versus clopidogrel-based DAPT.
- To evaluate outcomes including in-stent stenosis, stroke/TIA, and hemorrhage.
- To inform DAPT selection in patients undergoing flow diversion.
Main Methods:
- Retrospective analysis of 171 patients from 6 North American institutions.
- Patients received either aspirin + ticagrelor or aspirin + clopidogrel.
- Outcomes analyzed included in-stent stenosis, stroke/TIA, and bleeding events.
Main Results:
- No significant difference in in-stent stenosis (ISS), stroke/TIA, or hemorrhagic complications between DAPT groups after propensity-score weighting.
- Odds ratios for ISS, stroke/TIA, and hemorrhage were not significantly higher for clopidogrel compared to ticagrelor.
- The study found comparable safety and efficacy profiles for both regimens.
Conclusions:
- Aspirin plus ticagrelor DAPT is comparable in safety and efficacy to aspirin plus clopidogrel.
- Clopidogrel-based DAPT should be considered first-line for preventing ischemic complications.
- Ticagrelor use does not increase hemorrhagic risk in cases of clopidogrel resistance.
Background And Objectives:
Dual antiplatelet therapy (DAPT) is an essential component of medical management after flow diversion. To our knowledge, no studies have compared DAPT regimens using ticagrelor vs clopidogrel in patients undergoing flow diversion with newer generation surface-modified stents. Our study compares outcomes of flow diversion between ticagrelor- and clopidogrel-based DAPT.
Methods:
This was a retrospective analysis of patients who underwent flow diversion with surface-modified stents at 6 participating institutions in North America. Patients were dichotomized based on DAPT regimen into acetyl salicylic acid (ASA) + ticagrelor vs ASA + clopidogrel. Outcomes of interest were in-stent stenosis (ISS), stroke or transient ischemic attack (TIA), and hemorrhagic complications on follow-up.
Results:
Of 171 patients, 48.5% (n = 83) received ticagrelor and 51.4% (n = 88) received clopidogrel. A total of 13.4% patients (n = 23) developed ISS, 6.4% (n = 11) developed stroke/TIA, and 3.5% (n = 6) developed hemorrhagic complications After propensity-score weighting, patients who received clopidogrel did not have higher odds for ISS (odds ratio [OR]: 0.63, 95% CI: 0.25-1.59, P = .333), stroke/TIA (OR: 0.68, 95% CI: 0.19-2.43, P = .555), or hemorrhagic complications (OR: 0.17, 95% CI: 0.02-1.51, P = .113), compared with those receiving ticagrelor.
Conclusion:
DAPT with ASA and ticagrelor demonstrated comparable safety and efficacy to ASA and clopidogrel. Clopidogrel-based DAPT regimens should be considered as first line in preventing ischemic complications. However, in case of clopidogrel resistance, the use of ticagrelor does not confer increased risk of hemorrhagic complications.
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