A recent data presentation has revealed reduced risk of stroke and mortality among transcarotid artery revascularisation (TCAR) patients who receive dual antiplatelet therapy (DAPT), at discharge, as compared to other drug regimens. Researchers believe these findings underscore the importance of compliance to DAPT regimens before and after a TCAR procedure.
At the Society for Clinical Vascular Surgery (SCVS) annual symposium (25–29 March 2023, Miami, USA), Hanaa Dakour-Aridi (Indiana University School of Medicine, Indianapolis, USA) and S Keisin Wang (The University of Texas Health Science Center, Houston, USA) presented the results of a study evaluating post-TCAR discharge regimens in patients within the Vascular Quality Initiative (VQI) registry.
The study found that 19.2% of patients in the VQI are not discharged on dual antiplatelets after stent placement via TCAR—9% receive a ‘triple therapy’ involving DAPT plus anticoagulation, 5.8% are given single antiplatelet therapy (SAPT) plus anticoagulation, and 4% are directed to take either SAPT or a single anticoagulant.
“We demonstrated that patients discharged on a combination of single antiplatelets with anticoagulation witnessed increased [rates of] 30-day stroke, high-grade restenosis, and one-year mortality and stroke/death,” Dakour-Aridi noted. “The use of a single antiplatelet or single anticoagulant after TCAR was associated with increased 30-day and one-year stroke/death risks. However, there was no significant association between triple therapy and 30-day stroke/death outcomes [following multivariate analysis adjustments].”
Highlighting the limitations of the present study, she touched on the absence of indications information for antiplatelet regimens on discharge in the VQI—increasing the likelihood of selection bias—as well as limited data at follow-up (52% at 30 days and 45% at one year), and the unknown risk of bleeding with triple therapy.
Nevertheless, Dakour-Aridi concluded that “[…] these findings reinforce our prior study on the importance of compliance to DAPT after TCAR, as well as the need for further follow-up studies to evaluate the appropriateness of TCAR in different patient populations”.
The prior study in question saw Dakour-Aridi and her colleagues publish comparable findings in the Journal of Vascular Surgery—with the key distinction being that, here, they examined the association between different preoperative antiplatelet regimens and in-hospital outcomes after TCAR. This research ultimately produced similar results, as DAPT demonstrated improved clinical outcomes, including reduced in-hospital stroke and mortality risks, compared to other medication regimens in carotid artery disease patients undergoing a TCAR procedure.
