From the Research
Patients should be kept on dual anti-platelet therapy (DAPT) for at least 5-7 days before receiving a flow diverting stent treatment for intracranial aneurysms, with the most recent evidence suggesting that the duration of DAPT may be shortened if patients have a periprocedural period without events 1. The standard DAPT regimen consists of aspirin 325 mg daily and clopidogrel 75 mg daily.
- In some cases, a loading dose of clopidogrel (300-600 mg) may be given 24 hours before the procedure if there isn't enough time for the full 5-7 day course.
- Alternative P2Y12 inhibitors like ticagrelor or prasugrel may be used instead of clopidogrel in patients who are poor responders or have contraindications. It's crucial to start this therapy before the procedure to ensure adequate platelet inhibition and reduce the risk of thromboembolic complications during and after stent placement.
- The pre-treatment allows time for the medications to reach their full antiplatelet effect.
- Platelet function testing may be performed to assess the patient's response to the therapy, with adjustments made if necessary. This pre-procedure DAPT is distinct from the long-term DAPT regimen that patients will continue after the stent placement, which typically lasts for at least 3-6 months. The most recent study 1 found that thromboembolic events rarely occurred beyond 30 days after SAC/FD, suggesting that the duration of DAPT may be shortened if patients have a periprocedural period without events. However, further prospective studies are warranted to determine the optimal duration of antiplatelet therapy. The use of ticagrelor or prasugrel was associated with a lower risk of mortality compared with clopidogrel 2, but the overall number of neurological complications was lower when a lower dose of heparin was administered 3.