From the Research
Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel should be administered for at least 3-6 months before flow diverting stent treatment for cerebral aneurysms, with the most recent evidence suggesting that the duration may be shortened to more than 90 days if patients have a periprocedural period without events 1. The most common regimen involves aspirin 325 mg daily and clopidogrel 75 mg daily, starting with a loading dose of 325-650 mg of aspirin and 300-600 mg of clopidogrel, followed by the daily maintenance doses. It's crucial to start this therapy before the procedure to ensure adequate platelet inhibition at the time of stent placement. The dual anti-platelet therapy helps prevent thromboembolic complications, which are a significant risk with flow diverting stents due to their high metal surface area and the manipulation of intracranial vessels during deployment. Some key points to consider when administering DAPT include:
- Platelet function testing is often performed before the procedure to ensure adequate response to the medications.
- If a patient shows resistance to clopidogrel, alternatives like ticagrelor or prasugrel may be considered.
- The therapy is typically continued for at least 3-6 months after the procedure, with aspirin often continued indefinitely.
- Close monitoring and adjustment of the regimen may be necessary, especially in the immediate post-procedural period.
- The exact duration and medication choices can vary based on individual patient factors, institutional protocols, and the specific type of flow diverter used. It's also important to note that the optimal duration of DAPT is still a topic of debate, with some studies suggesting that a shorter duration may be sufficient in certain patients 2, 3, 4, 5. However, the most recent and highest quality study suggests that a duration of more than 90 days may be sufficient in patients with a periprocedural period without events 1.