Key result
Uninterrupted DOAC plus single antiplatelet yields zero bleeding or thromboembolic events post-CAS.
Why the study?
Periprocedural antithrombotic management in patients with NVAF undergoing CAS is controversial due to bleeding risk with triple therapy and thromboembolic risk with DOAC interruption.
Observational (n=10)
No
An uninterrupted dual antithrombotic strategy of a DOAC and single antiplatelet therapy for carotid artery stenting in patients with NVAF appears feasible and was not associated with major bleeding or thromboembolic events.
Supports feasibility of uninterrupted DOAC plus single antiplatelet for CAS in NVAF; hypothesis-generating and requires prospective confirmation before practice change.
Objective: Periprocedural antithrombotic management in patients with non-valvular atrial fibrillation (NVAF) undergoing carotid artery stenting (CAS) remains controversial. Although dual antiplatelet therapy is the standard regimen for CAS, its combination with a direct oral anticoagulant (DOAC) as triple therapy increases bleeding risk. On the other hand, interruption of DOAC therapy may increase thromboembolic risk. We evaluated the clinical outcomes and feasibility of an uninterrupted dual antithrombotic therapy (DAT) strategy consisting of a DOAC and single antiplatelet therapy (SAPT). Methods: We retrospectively reviewed a case series of 10 patients with NVAF treated between 2018 and 2025 who underwent CAS while continuing DOAC plus SAPT without interruption. In all cases, SAPT (clopidogrel, aspirin, or prasugrel) was initiated at least 2 weeks before the procedure. Platelet function was assessed using the VerifyNow system (Werfen, Bedford, MA, USA). We evaluated baseline clinical characteristics, antithrombotic regimens, platelet reactivity, procedural details, and periprocedural clinical outcomes. Results: -VASc and HAS-BLED scores were 4.4 ± 1.4 and 3.8 ± 1.0, respectively. CAS was successfully performed in all patients. One patient with elevated P2Y12 reaction units required the temporary periprocedural addition of cilostazol. No periprocedural hemorrhagic or thromboembolic complications occurred during the periprocedural period or within 3 months after CAS. Conclusion: Uninterrupted DAT with a DOAC and SAPT may be a feasible periprocedural management strategy for CAS in patients with NVAF, without the need for DOAC interruption or triple therapy.
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Suzuki et al. (2026) conducted an observational in Non-valvular atrial fibrillation undergoing carotid artery stenting (n=10). Uninterrupted dual antithrombotic therapy (DOAC plus single antiplatelet therapy) was evaluated on Any clinical thromboembolic or hemorrhagic event during the periprocedural period and within 3 months after CAS. Uninterrupted dual antithrombotic therapy with a DOAC and single antiplatelet therapy resulted in zero hemorrhagic or thromboembolic events within 3 months post-carotid artery stenting.
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