ArticleStroke and vascular neurology2026
Associations of new intracranial haemorrhage, ischaemic stroke and survival with dual antiplatelet therapy regimen or duration after endovascular treatment for ruptured cerebral aneurysm.
Article in Stroke and vascular neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDual antiplatelet therapy (DAPT) is often necessary following endovascular treatment for ruptured cerebral aneurysms; however, the optimal drug combination and treatment duration remain uncertain.
methodPatients with subarachnoid haemorrhage secondary to ruptured cerebral aneurysms were identified from the TriNetX database. Subjects were categorised based on DAPT regimen (aspirin+clopidogrel vs aspirin+ticagrelor) and duration (≥1 month, ≥3 months, ≥6 months). Propensity score matching was performed, and outcomes including new onset intracranial haemorrhage, ischaemic stroke and overall survival were compared.
resultsA total of 2775 patients were included in the regimen analysis, with 725 matched in each group. At the 1-month follow-up, the ORs for new intracranial haemorrhage and ischaemic stroke in the aspirin+clopidogrel group were 1.11 (95% CI 0.71 to 1.75) and 0.97 (95% CI 0.59 to 1.59), respectively, with no significant differences at mid-term or long-term follow-up. However, survival analysis revealed a statistically significant difference at the 6-month follow-up favouring the clopidogrel group (OR 0.65; 95% CI, 0.44 to 0.97). In the duration analysis, 465 patients were matched for the 1-month versus 3-month groups, and 355 for the 3-month versus 6-month groups. ORs for ischaemic stroke were 1.06 (95% CI 0.67 to 1.67) and 1.24 (95% CI 0.76 to 2.01), respectively. No significant differences in survival were observed based on log-rank tests.
conclusionOur real-world data analysis revealed no significant differences in ischaemic or haemorrhagic outcomes between the aspirin+clopidogrel and aspirin+ticagrelor regimens. However, the observed differences in survival suggest the need for more refined patient selection strategies. In addition, the appropriate duration of DAPT is still unknown, although our results suggest that a shorter DAPT duration may offer comparable safety and efficacy.
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