Impact of antithrombotic therapy on outcomes of incidental unruptured intracranial aneurysms in patients with ischemic stroke

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke with concomitant saccular unruptured intracranial aneurysms (n=197). Intervention: Anticoagulation vs. Single antiplatelet therapy (SAPT). Primary outcome: Aneurysm rupture (OR 0.41, 95% CI 0.01-5.21, p=0.52).

Q: What does this research mean for the field?

Standard antithrombotic secondary stroke prevention regimens, including anticoagulation and antiplatelet therapies, are not associated with an increased risk of aneurysm rupture in patients with acute ischemic stroke and small incidental unruptured intracranial aneurysms. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chao Chen; Yiya Xu; Yingchao He; Ting Chen; Xingyong Chen

doi:10.1080/07853890.2026.2705593

July 30, 2026Annals of MedicineOpen Access

Impact of antithrombotic therapy on outcomes of incidental unruptured intracranial aneurysms in patients with ischemic stroke

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Key result

Anticoagulation shows no increased unruptured intracranial aneurysm rupture risk over single antiplatelet therapy.

Why the study?

Does antithrombotic therapy increase the risk of aneurysm rupture in patients with acute ischemic stroke and incidental unruptured intracranial aneurysms?

Key Points

To determine whether secondary prevention antithrombotic regimens increase the risk of aneurysm rupture, enlargement, or neurological symptoms in patients with acute ischemic stroke and concomitant unruptured intracranial aneurysms.
Single-center retrospective cohort study of 197 patients with acute ischemic stroke and concomitant saccular unruptured intracranial aneurysms between January 2016 and December 2021.
Categorized patients by long-term regimen: single antiplatelet therapy (n=140), anticoagulation (n=36), or no regular therapy (n=21), with acute short-term dual antiplatelet therapy (n=66) analyzed separately.
Assessed primary endpoint of aneurysm rupture and secondary endpoints of new attributable symptoms and radiographic growth (≥1 mm enlargement) over a mean follow-up of 28.6 ± 18.4 months.
Aneurysm rupture occurred in 1.0% of patients overall (2/197; 95% exact CI, 0.1%–3.6%), occurring in 0.7% (95% CI, 0.02%–4.1%) of the single antiplatelet group, 0% (95% CI, 0%–9.7%) of the anticoagulation group, and 4.8% (95% CI, 0.1%–23.8%) of the untreated group.
Dual antiplatelet therapy bridging was not associated with aneurysm rupture (0/66 [0%; 95% CI, 0%–5.4%] vs 2/131 [1.5%; 95% CI, 0.2%–5.4%]; p > 0.99).
Secondary outcomes of new attributable symptoms occurred in 3.0% of patients (6/197; 95% exact CI, 1.1%–6.5%), and asymptomatic radiographic growth occurred in 1 patient in the single antiplatelet therapy group.

Study Design

Type

Cohort (n=197)

Multicenter

No

Structured PICO

Does antithrombotic therapy increase the risk of aneurysm rupture in patients with acute ischemic stroke and incidental unruptured intracranial aneurysms?

P

Population

197 adults with acute ischemic stroke and concomitant saccular unruptured intracranial aneurysms, followed for a mean of 28.6 months.

E

Exposure

Long-term anticoagulation (DOACs or warfarin)

C

Comparator

Long-term single antiplatelet therapy (SAPT: aspirin, clopidogrel, or cilostazol)

O

Outcome

Aneurysm rupture (confirmed aneurysmal subarachnoid hemorrhage) over a mean follow-up of 28.6 monthshard clinical

Main Result

Odds Ratio: 0.41 (95% CI 0.01–5.21)

Absolute Event Rate: 0% vs 0.7%

p-value: p=0.52

Limitations

Retrospective single-center design
Modest sample size limiting statistical power
Non-protocolized follow-up imaging
Potential confounding by indication
Small number of events
Modest sample size

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Implication

Standard antithrombotic therapy for secondary stroke prevention does not appear to increase the risk of aneurysm rupture in patients with concomitant small saccular unruptured intracranial aneurysms.

Abstract

BACKGROUND: The coexistence of acute ischemic stroke (AIS) and unruptured intracranial aneurysms (UIAs) is relatively common, but the safety of antithrombotic therapy in this population remains uncertain. This study evaluated whether different secondary prevention regimens influence UIA progression or rupture risk. METHODS: This single-center retrospective cohort study included patients with AIS and concomitant saccular UIAs between January 2016 and December 2021. Patients were categorized according to long-term antithrombotic exposure: single antiplatelet therapy (SAPT), anticoagulation, or no regular therapy. Dual antiplatelet therapy (DAPT) was analyzed separately. The primary outcome was aneurysm rupture; secondary outcomes included symptomatic events and radiographic progression (≥1 mm growth). CONCLUSIONS: In patients with small incidental saccular UIAs and AIS, standard secondary prevention regimens were not associated with an increased risk of aneurysm rupture. However, the limited number of rupture events and potential residual confounding warrant cautious interpretation. Secondary stroke prevention should remain the priority, with individualized assessment of aneurysm-related risks.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Acute ischemic stroke with concomitant saccular unruptured intracranial aneurysms (n=197). Anticoagulation vs. Single antiplatelet therapy (SAPT) was evaluated on Aneurysm rupture (OR 0.41, 95% CI 0.01-5.21, p=0.52). In patients with acute ischemic stroke and incidental saccular unruptured intracranial aneurysms, anticoagulation was not significantly associated with increased aneurysm rupture compared to single antiplatelet therapy (OR 0.41, p=0.52).

synapsesocial.com/papers/6a6d9825e258b358b3c6b1e5 https://doi.org/10.1080/07853890.2026.2705593

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Impact of antithrombotic therapy on outcomes of incidental unruptured intracranial aneurysms in patients with ischemic stroke

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Impact of antithrombotic therapy on outcomes of incidental unruptured intracranial aneurysms in patients with ischemic stroke

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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