Neurovascular Nuggets_ Navigating DAPT Duration Post-SACE

Main Points - This was a multicenter randomized controlled trial comparing long-term (12 months) vs short-term (3 months) dual antiplatelet therapy (DAPT) with aspirin and clopidogrel after stent-assisted coil embolization (SACE) for cerebral aneurysms. - 142 patients were recruited and randomized. The primary outcome was ischemic stroke rate during 3-12 months after SACE. - There was no significant difference in ischemic stroke rates between the long-term and short-term DAPT groups (0 vs 2.1 per 100 person-years). - Rates of the secondary outcomes (death/any stroke, hemorrhagic events, death/stroke/hemorrhage, retreatment/stent issues) were also not significantly different between groups. - The trial was underpowered due to lower than expected enrollment and event rates. Implications for Clinical Practice - This trial did not find a statistically significant benefit of long-term over short-term DAPT after SACE, but was underpowered to definitively determine this. - The low ischemic event rates suggest DAPT for 3-6 months is likely sufficient for many patients after SACE with newer generation stents. However, longer DAPT may still benefit some high thromboembolic risk patients. - Platelet function testing to guide personalized DAPT duration decisions may be useful. Patients at high hemorrhagic risk may also benefit from shorter DAPT. - Large definitive randomized trials are still needed to determine optimal DAPT duration after SACE. In the meantime, decisions can be individualized based on thromboembolic vs hemorrhagic risk factors Read more at hashtag#neurovascularnuggets https://lnkd.in/dC9Wxhxt