Short-term dual antiplatelet therapy effective after carotid artery stenting, claims research

A recent study published in the Stroke; a Journal of Cerebral Circulation found that short-duration dual antiplatelet therapy (DAPT) is as effective and safe as long-duration DAPT for patients undergoing carotid artery stenting (CAS). The findings could help clinicians to optimize post-procedure treatment for patients at risk of complications from extended DAPT use.

Carotid artery stenting (CAS) is a less invasive alternative to carotid endarterectomy for patients with carotid artery stenosis which significantly increases the risk of ischemic stroke. After CAS, DAPT (combination of aspirin and clopidogrel) is prescribed to prevent clot formation and subsequent strokes. This study was set out to determine whether a shorter duration of DAPT could provide comparable protection while minimizing risks of bleeding or other adverse effects.

This research utilized data from the Korean Health Insurance Review and Assessment Service from 2007 to 2019 and analyzed outcomes for 12,034 patients who underwent CAS. This study divided patients into 2 groups based on the duration of DAPT where the patients who received DAPT for at least 90 days but less than six months were included in the Short-DAPT, while the Long-DAPT group comprised patients who maintained DAPT for longer than six months.

The primary outcome assessed was a composite of ischemic stroke, gastrointestinal bleeding, and intracranial hemorrhage within 12 months after transitioning to single antiplatelet therapy. Among the 12,034 patients studied, 2,529 were in the short-DAPT group, while 9,505 were in the long-DAPT group.

In the short-DAPT group, 41 patients (1.6%) experienced ischemic stroke, 22 patients (0.9%) had gastrointestinal bleeding, and 4 patients (0.2%) suffered intracranial hemorrhage. In the long-DAPT group, 108 patients (1.1%) had ischemic stroke, 87 patients (0.9%) experienced gastrointestinal bleeding, and 4 patients (0.04%) suffered intracranial hemorrhage.

The overall rate of the composite primary outcome was similar between the groups (2.5% for short-DAPT versus 2.1% for long-DAPT), with no statistically significant difference (adjusted hazard ratio 0.869; P=0.337). Overall, the study suggests that short-duration DAPT is a viable option after CAS by providing comparable clinical outcomes to long-duration DAPT in terms of stroke prevention and bleeding complications.

Reference:

Yoo, J., Lim, H., & Seo, K.-D. (2025). Optimal duration of dual antiplatelet therapy after carotid artery stenting: A nationwide cohort study. Stroke; a Journal of Cerebral Circulation. https://doi.org/10.1161/strokeaha.124.048743