ArticleClinical neuroradiology2026
Direct Comparison of Dual Antiplatelet Therapy with Prasugrel or Ticagrelor Versus Clopidogrel in Endovascular Treatment of Intracranial Aneurysms: a Meta-analysis.
Article in Clinical neuroradiology, 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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3 authors.
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Abstract
purposeClopidogrel (CPG)-based dual antiplatelet therapy (DAPT) is widely used prior to endovascular treatment of intracranial aneurysms to prevent procedural thromboembolic complications (TECs). Recently, newer-generation P2Y12 inhibitors - prasugrel and ticagrelor (PSG/TCG) - have emerged as potential alternatives. This meta-analysis aimed to evaluate the utility of PSG and TCG as first-line agents for DAPT by directly comparing their safety and efficacy with conventional CPG-based therapy.
methodRelevant studies were extracted from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials by two independent reviewers. A random-effects model was used to compare the risk of TECs and hemorrhagic complications (HECs) between PSG/TCG-based and CPG-based DAPT, expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses were performed to compare platelet reactivity, measured by platelet reaction unit (PRU) values, between the two groups.
resultsSix studies encompassing 1,071 patients were included. Compared with CPG-based DAPT, PSG/TCG-based DAPT was associated with a significantly lower risk of TECs (RR, 0.46; 95% CI, 0.23-0.93; p = 0.04) without a corresponding increase in HECs. Subgroup analysis demonstrated significantly lower PRU values in the PSG/TCG compared with the CPG group (p =0.01).
conclusionThis meta-analysis shows that PSG/TCG-based DAPT offers superior thromboembolic protection without increased hemorrhagic risk, compared to conventional CPG-based regimens in endovascular treatment of intracranial aneurysms. These results suggest that PSG/TCG-based DAPT is worth considering as a treatment option in this setting, and prospective randomized trials are needed to confirm these results and to evaluate its role as a first-line option.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.