No Safety Trade-Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy
Bibliographic record
Abstract
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.
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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) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".