A168 Three-month vs prolonged dual antiplatelet therapy after flow diversion: a multicenter landmark analysis

Résumé fourni par la source

Background/Introduction The optimal duration of dual antiplatelet therapy (DAPT) after flow diversion remains uncertain. While prolonged DAPT is widely used, the incremental benefit beyond the early post-procedural period is unclear, and extended therapy may increase bleeding risk. Objective/Purpose To evaluate whether a 3-month DAPT regimen after flow diversion is associated with comparable ischemic and hemorrhagic outcomes to prolonged DAPT in patients with unruptured intracranial aneurysms. Methods/Case Description We performed a retrospective analysis of prospectively collected data from three large post-market registries (PFLEX, SHIELD, INSPIRE-A) including patients treated with Pipeline devices under standard DAPT. Patients were stratified into short-term (76–104 days) and prolonged (≥105 days) DAPT. The primary analysis assessed ischemic and hemorrhagic events occurring after a 3-month landmark. Propensity score-adjusted logistic regression with multiple imputation was used to account for baseline differences. Results/Findings A total of 721 patients were included (short-term: n=172; prolonged: n=549). After the 3-month landmark, ischemic complications were rare and did not differ between groups (any ischemic stroke: 1.2% vs 0.5%; PS-adjusted OR 1.00, p=1.00). Hemorrhagic events were uncommon and similarly not different (major hemorrhage: 0.0% vs 0.9%, p=0.60; minor hemorrhage: 0.0% vs 0.5%, p=1.00). Exploratory analyses showed that hemorrhagic events occurred predominantly during active DAPT, whereas thromboembolic events occurred both during and after DAPT without a clear increase following discontinuation. Discussion/Conclusions/Learning Points Discontinuation of DAPT after 3 months was not associated with increased ischemic risk compared with prolonged therapy. Hemorrhagic events occurred predominantly during DAPT, whereas thromboembolic events occurred both during and after treatment without a clear increase after discontinuation. These findings, although limited by low event rates, support the feasibility of shorter DAPT strategies in selected patients.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.