Recent data presentations have revealed reduced risks of stroke and mortality among transcarotid artery revascularization (TCAR) patients who receive dual antiplatelet therapy (DAPT)—both preoperatively and 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 2023 Society for Clinical Vascular Surgery (SCVS) Annual Symposium (March 25–29) in Miami, Hanaa Dakour-Aridi, MD, a vascular surgery resident at Indiana University School of Medicine in Indianapolis, presented the results of a study evaluating post-TCAR discharge regimens in patients within the Vascular Quality Initiative (VQI) registry.
The data revealed 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 during SCVS 2023. “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 for antiplatelet regimens on discharge—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”.
Dakour-Aridi and her colleagues also recently published a similar study in the Journal of Vascular Surgery (JVS), with the key difference being that, here, they examined the association between preoperative antiplatelet regimens—DAPT vs. other 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.
