Adjusted antiplatelet therapy after stenting beneficial to unruptured intracranial aneurysm patients

Antiplatelet therapy guided by platelet function monitoring helps prevent thromboembolic events among patients with unruptured intracranial aneurysm who have undergone stent placement but at the cost of higher minor or minimal bleeding events, according to data from an open-label study.

The study randomized 314 patients to receive either drug adjustment (patients who had high on-treatment platelet reactivity to antiplatelet therapy on the basis of platelet function monitoring [monitoring group]; n=157) or conventional therapy (without monitoring and drug adjustment; n=157). Patients who received drug adjustment were monitored for the second time 14 days after randomization.

The primary outcome of the composite frequency of ischaemic stroke, transient ischaemic attack, stent thrombosis, urgent revascularization, and cerebrovascular death within 7 days after stenting was higher in the conventional group than in the monitoring group (12.1 percent vs 5.1 percent). Cox proportional hazards analysis confirmed the beneficial effect of monitoring on the outcome (hazard ratio [HR], 0.39, 95 percent confidence interval [CI], 0.17–0.92; p=0.03).

The lower frequency of the primary composite outcome in the monitoring group was driven by the significantly lower incidence of ischaemic stroke (4.5 percent vs 12.1 percent; HR, 0.34, 95 percent CI, 0.14–0.83; p=0.01).

However, the safety outcome of the composite frequency of major, minor, or minimal bleeding within 1 month after stenting was higher in the monitoring than in the conventional group (7.0 percent vs 1.9 percent; HR, 3.87, 95 percent CI, 1.06–14.14; p=0.03).

Specifically, minor or minimal bleeding events occurred more frequently in the monitoring vs conventional group (6.4 percent vs 1.3 percent; p=0.02). There was no between-group difference in the frequency of major bleeding events.