No Safety Trade-Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy
Notice bibliographique
Résumé
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.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».