Triple or Double? Safety Holds Steady in Acute Stenting
Bibliographic record
Abstract
Background: Acute stenting is typically performed for patients presenting with focal neurological deficits due to intracranial or extracranial atherosclerotic stenosis. Following the procedure, dual antiplatelet therapy (DAPT) regimen is commonly prescribed to reduce the risk of in-stent thrombosis. However, very few studies have examined safety outcomes in patients already on direct oral anticoagulants (DOACs) who undergo acute carotid or intracranial stenting with subsequent dual anti-platelet regimen (DAPT). The combination of DOAC and DAPT, referred here as triple therapy, is controversial given the increased risk of hemorrhagic transformation. This retrospective cohort study aims to analyze the safety of triple therapy in patients who undergo acute carotid or intracranial stenting by assessing the rates of adverse outcomes of patients whether they were on triple therapy with DOACs and DAPT, or DAPT only. Methods: A prospectively maintained endovascular database was reviewed to identify patients ongoing only acute carotid or intracranial stenting between 2013 and 2025 at a comprehensive stroke center. Patients were categorized based on whether they were managed with oral anticoagulation prior to acute stenting. Collected demographic data included 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 mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable. No triple therapy patients had a recorded NIHSS score at three months leading to exclusion of the variable in analysis. Results: Of the 58 patients who met inclusion criteria of acute stenting, 18 were already on DOACs, 72.2% of whom are male. Based on patient demographics, there was a significant difference in rates of coronary artery disease (CAD, 44.4% triple therapy cohort vs. 12.5% DAPT-only cohort, p=0.014) and hyperlipidemia (HLD, 77.8% triple therapy cohort vs. 45.0% DAPT-only cohort, p=0.025). After adjusting for NIHSS score on admission, age, CAD, and HLD, discharge mRS was found to be significantly lower in the triple therapy group median [IQR] of 3.5 [1.75-4] in the triple therapy group vs. 4 [3-5] in the DAPT only group. All other safety and functional outcomes displayed no statistically significant difference between the two groups. Conclusion: Patients undergoing acute carotid or intracranial stenting who are already on anticoagulation therapy may be safely managed with a triple-therapy regimen. Our findings demonstrate improved functional outcomes at discharge and show no significant difference in safety or other functional outcomes, supporting the safe and effective use of triple therapy in patients undergoing acute stenting.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 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 teacher head, 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".