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Background <p>The optimal duration of dual antiplatelet therapy (DAPT) following endovascular treatment of intracranial aneurysms remains uncertain. While DAPT effectively prevents thromboembolic complications, prolonged therapy may increase bleeding risk. This systematic review and meta-analysis compared the efficacy and safety of short-term versus long-term DAPT in patients undergoing endovascular treatment with stent-assisted coiling or flow diversion.</p> Methods <p>We conducted a systematic review and meta-analysis according to PRISMA guidelines. Studies were identified through PubMed, Embase and Cochrane from inception to January 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts comparing short-term DAPT (≤ 6&#xa0;months) with long-term DAPT (&gt; 6&#xa0;months) in adults treated for intracranial aneurysms. Pooled risk ratio (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies.</p> Results <p>Seven studies, comprising a total of 17,380 patients, were included, one RCT and six retrospective cohorts. The pooled analysis showed no significant difference in thromboembolic events between short- and long-term DAPT (RR: 1.18; 95% CI: 0.42–3.30; I<sup>2</sup> = 60.5%). Short-term DAPT was associated with a lower risk of major bleeding (RR: 0.54; 95% CI: 0.32–0.91; I<sup>2</sup> = 0%). No significant differences were observed between groups in retreatment (RR: 0.94; 95% CI: 0.24–3.62) or mortality (RR: 3.11; 95% CI: 0.96–10.09).</p> Conclusions <p>Short-term DAPT demonstrates similar efficacy to long-term DAPT in preventing thromboembolic events and retreatment, with a lower incidence of major bleeding. These findings suggest that shorter DAPT regimens may offer a favorable safety profile. However, further large-scale RCTs are needed to establish definitive guidelines.</p>

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Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年7月31日

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  • Anderson Matheus Pereira da Silva,
  • Ocílio de Deus,
  • Luciano Falcão,
  • Mariana Lee Han,
  • Filipe Virgilio Ribeiro,
  • Pedro Lucas Machado Magalhães,
  • Altair Melo Neto,
  • Othon Trevisan Meira,
  • Mariana Leticia Bastos Maximiano,
  • Gustavo Sousa Noleto,
  • Ahmet Günkan,
  • Pascal M. Jabbour

摘要

Background

The optimal duration of dual antiplatelet therapy (DAPT) following endovascular treatment of intracranial aneurysms remains uncertain. While DAPT effectively prevents thromboembolic complications, prolonged therapy may increase bleeding risk. This systematic review and meta-analysis compared the efficacy and safety of short-term versus long-term DAPT in patients undergoing endovascular treatment with stent-assisted coiling or flow diversion.

Methods

We conducted a systematic review and meta-analysis according to PRISMA guidelines. Studies were identified through PubMed, Embase and Cochrane from inception to January 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts comparing short-term DAPT (≤ 6 months) with long-term DAPT (> 6 months) in adults treated for intracranial aneurysms. Pooled risk ratio (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies.

Results

Seven studies, comprising a total of 17,380 patients, were included, one RCT and six retrospective cohorts. The pooled analysis showed no significant difference in thromboembolic events between short- and long-term DAPT (RR: 1.18; 95% CI: 0.42–3.30; I2 = 60.5%). Short-term DAPT was associated with a lower risk of major bleeding (RR: 0.54; 95% CI: 0.32–0.91; I2 = 0%). No significant differences were observed between groups in retreatment (RR: 0.94; 95% CI: 0.24–3.62) or mortality (RR: 3.11; 95% CI: 0.96–10.09).

Conclusions

Short-term DAPT demonstrates similar efficacy to long-term DAPT in preventing thromboembolic events and retreatment, with a lower incidence of major bleeding. These findings suggest that shorter DAPT regimens may offer a favorable safety profile. However, further large-scale RCTs are needed to establish definitive guidelines.