Abstract 341: No Safety Trade‐Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy
Bibliographic record
Abstract
Background Patients undergoing intra‐ or extracranial stenting are typically placed on a dual antiplatelet therapy (DAPT) regimen to decrease the risk of in‐stent thrombosis. However, initiating DAPT in patients already on oral anticoagulants (OACs) is controversial due to the increased risk of hemorrhagic transformation. Studies have been done on patients with atrial fibrillation on OACs undergoing coronary stenting with subsequent DAPT initiation, but there are no corollaries for patients undergoing acute carotid or intra‐cranial stenting where the risk for hemorrhage or hemorrhagic transformation (HT) is higher. This retrospective cohort study aims to bridge that understanding and checked whether patients with acute ischemic stroke (AIS) requiring mechanical thrombectomy (MT) and stenting experienced different rates of adverse outcomes depending on whether they were on triple therapy with DAPT and OACs, or DAPT only. Methods A prospectively maintained endovascular database was searched for patients presenting with AIS who underwent MT with carotid or intra‐cranial stenting during the same procedural session from 2013 to 2025 at a comprehensive stroke center, and categorized by prior anticoagulation use. Demographics, manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admission NIHSS (National Institute of Health Stroke Scale) scores were compared. Safety and functional outcomes include HT, mass effect, mortality, symptomatic and asymptomatic intracranial hemorrhage, NIHSS at discharge, and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable. NIHSS at three months was omitted due to heavily skewed distribution. Results Of the 186 patients who met inclusion criteria, 63 were already on OACs, 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 outcomes displayed any significant differences in the two groups. Conclusion In this single‐center retrospective cohort, patients on OAC undergoing MT with stenting did not experience increased hemorrhagic or functional complications when treated with triple therapy compared with DAPT alone. These findings suggest triple therapy may be safe in this setting, but prospective multicenter validation is warranted. image
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".