Short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm: a meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Un-ruptured cerebral aneurysm (n=1162). Intervention: Ticagrelor + aspirin vs. Clopidogrel + aspirin. Primary outcome: Ischemic stroke (RR 0.66, 95% CI 0.38 - 1.15, p=0.15).

Q: What does this research mean for the field?

Ticagrelor combined with aspirin and clopidogrel combined with aspirin show comparable short-term risks of ischemic stroke, hemorrhagic stroke, mortality, and bleeding events following endovascular therapy for unruptured cerebral aneurysms. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Bei Fu; Nan Nuan Liu; Yao Liu

doi:10.1186/s12883-026-05376-5

September 22, 2026BMC NeurologyOpen Access

Short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm: a meta-analysis

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Key result

Ticagrelor plus aspirin shows no benefit over clopidogrel plus aspirin for ischemic stroke after endovascular therapy.

RR 0.66
95% CI 0.38 - 1.15
P=0.15
n=1,162

Why the study?

The risk of thromboembolic events after endovascular therapy for un-ruptured cerebral aneurysms and the optimal antiplatelet regimen remain concerns requiring evaluation of short term clinical outcomes.

Does ticagrelor + aspirin improve short-term clinical outcomes compared to clopidogrel + aspirin in patients undergoing endovascular therapy for un-ruptured cerebral aneurysm?

Key Points

To assess short-term clinical outcomes associated with ticagrelor plus aspirin compared to clopidogrel plus aspirin following endovascular therapy for un-ruptured cerebral aneurysms.
Systematic review and meta-analysis of online electronic databases identifying studies comparing ticagrelor plus aspirin to clopidogrel plus aspirin with follow-up ≤ 6 months.
Included 7 retrospective studies published between 2003 and 2021 with a total sample size of N=1162 (558 treated with ticagrelor plus aspirin and 604 treated with clopidogrel plus aspirin).
Calculated pooled risk ratios (RR) with 95% confidence intervals (CI) using RevMan software across stroke, mortality, and bleeding endpoints.
Ticagrelor plus aspirin showed no significant difference compared to clopidogrel plus aspirin for ischemic stroke (RR: 0.66, 95% CI: 0.38–1.15; P = 0.15) or hemorrhagic stroke (RR: 1.01, 95% CI: 0.28–3.60; P = 0.99).
Short-term mortality (RR: 1.01, 95% CI: 0.33–3.11; P = 0.98), major bleeding (RR: 0.94, 95% CI: 0.30–2.94; P = 0.92), and minor bleeding (RR: 0.36, 95% CI: 0.06–1.97; P = 0.24) were not significantly different between regimens.

Study Design

Type

Meta-Analysis (n=1,162)

Structured PICO

Does ticagrelor + aspirin improve short-term clinical outcomes compared to clopidogrel + aspirin in patients undergoing endovascular therapy for un-ruptured cerebral aneurysm?

P

Population

1,162 patients with un-ruptured cerebral aneurysms undergoing endovascular therapy from 7 observational studies, followed for up to 6 months.

I

Intervention

Ticagrelor + aspirin

C

Comparator

Clopidogrel + aspirin

O

Outcome

Short term clinical outcomes (≤ 6 months) including ischemic stroke, hemorrhagic stroke, mortality, major bleeding, and minor bleedinghard clinical

Main Result

Relative Risk: 0.66 (95% CI 0.38–1.15)

p-value: p=0.15

Ticagrelor plus aspirin is equally effective and safe as clopidogrel plus aspirin for short-term outcomes following endovascular therapy for un-ruptured cerebral aneurysms.

Limitations

Limited number of participants
Inclusion of some patients with ruptured cerebral aneurysms in a few studies
All included studies were observational, introducing potential selection bias and confounding
Few studies involved in subgroup analyses
Unable to assess publication bias with Egger's and Begg's tests due to inclusion of fewer than 10 studies
Inclusion of some patients with ruptured cerebral aneurysm in one or two studies
Inclusion of only non-randomized observational studies, which are vulnerable to biases like selection bias and confounding
Inability to assess publication bias via Egger's and Begg's tests due to inclusion of less than 10 studies

Implication

Ticagrelor plus aspirin was associated with lower thromboembolic events without increased hemorrhage; extends observational data but leaves open need for randomized confirmation.

Abstract

Nowadays endovascular therapy has become the first line treatment for the management of patients with un-ruptured intracranial aneurysms. However, the risk of thromboembolic events secondary to the use of intracranial stents is a major concern. The use of anti-platelet agents following this minimally invasive procedure is vital. In this analysis, we aimed to show the short term clinical outcomes associated with the use of ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm. Online electronic databases were searched for studies comparing ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm. Short term clinical outcomes (≤ 6 months) including ischemic and hemorrhagic stroke, mortality, major and minor bleeding events were considered the endpoints. Revman software was used to analyze data and risk ratios (RR) with 95% confidence intervals (CI) were used to represent the results. A total number of 1162 participants were included in this analysis. Five hundred and fifty eight (558) participants were treated with ticagrelor + aspirin whereas 604 participants were treated with clopidogrel + aspirin. Our results showed both ticagrelor and clopidogrel in combination with aspirin to be associated with a similar risk of ischemic stroke (RR: 0.66, 95% CI: 0.38 – 1.15; P = 0.15), hemorrhagic stroke (RR: 1.01, 95% CI: 0.28 – 3.60; P = 0.99), mortality (RR: 1.01, 95% CI: 0.33 – 3.11; P = 0.98), major bleeding (RR: 0.94, 95% CI: 0.30 – 2.94; P = 0.92) and minor bleeding (RR: 0.36, 95% CI: 0.06 – 1.97; P = 0.24). The short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm were not significantly different. Both anti-platelet regimens were equally effective following endovascular therapy for un-ruptured cerebral aneurysm during this short term follow-up. However, due to the extraction of data from observational studies as well as a limited number of participants, this hypothesis should be confirmed in larger studies.

Discussion

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Cite This Study

Fu et al. (2026) conducted a meta-analysis in Un-ruptured cerebral aneurysm (n=1,162). Ticagrelor + aspirin vs. Clopidogrel + aspirin was evaluated on Ischemic stroke (RR 0.66, 95% CI 0.38 - 1.15, p=0.15). Ticagrelor plus aspirin showed no significant difference in the risk of short-term ischemic stroke (RR 0.66) compared to clopidogrel plus aspirin following endovascular therapy for un-ruptured cerebral aneurysms.

synapsesocial.com/papers/6ab60ea4406bf401c1467267 https://doi.org/10.1186/s12883-026-05376-5

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Short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm: a meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm: a meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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