Why the study?
Standard peri-operative DAPT for carotid artery stenting is associated with antiplatelet resistance-related ischemic events and hemorrhagic complications, prompting investigation into the feasibility of prasugrel monotherapy.
Does single antiplatelet therapy with prasugrel reduce ischemic and hemorrhagic complications compared to dual antiplatelet therapy with aspirin and clopidogrel in patients undergoing elective carotid artery stenting?
Does single antiplatelet therapy with prasugrel reduce ischemic and hemorrhagic complications compared to dual antiplatelet therapy with aspirin and clopidogrel in patients undergoing elective carotid artery stenting?
Single antiplatelet therapy with prasugrel may be a feasible alternative to standard dual antiplatelet therapy for patients undergoing elective carotid artery stenting, showing similar short-term ischemic and bleeding outcomes.
Prasugrel SAPT was associated with similar short-term rates to DAPT after carotid stenting; hypothesis-generating and requires randomized confirmation.
Background Dual antiplatelet therapy (DAPT) is used peri-operatively as standard care for patients who undergo carotid artery stenting (CAS). Nonetheless, this regimen is associated with several problems, including ischemic complications due to antiplatelet resistance, as well as hemorrhagic complications. This study investigated the feasibility of single antiplatelet therapy (SAPT) with prasugrel for CAS. Methods Records of consecutive patients who underwent elective CAS between January 2015 and December 2024 were reviewed. Patients administered SAPT with prasugrel and those administered DAPT with aspirin and clopidogrel were compared. The P2Y12 reaction unit (PRU) was measured using VerifyNow System. Effectiveness and safety outcomes were defined as ischemic and hemorrhagic complications within 3 months of CAS. Results A total of 146 patients were included in this analysis. The absolute PRU value was significantly lower in the SAPT group than in the DAPT group (128.5 vs 163.0, P < 0.01). The rate of ischemic events within 3 months did not significantly differ (SAPT vs DAPT, 0.0% vs 3.7%, P = 0.53). The rate of hemorrhagic complications also showed no significant difference (SAPT vs DAPT, 5.3% vs 0.9%, P = 0.34). Four patients in the SAPT group and twelve patients in the DAPT group regularly took anticoagulants, and the rate of bleeding events did not significantly differ between them. Conclusions Prasugrel ensured an adequately low PRU value compared with clopidogrel. SAPT with prasugrel may be an alternative to DAPT in patients undergoing CAS without increasing the risk of complications. This regimen may be used safely, even in patients who regularly use anticoagulants.
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Kinoshita et al. (2025) studied this question.
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