Abstract 341: No Safety Trade‐Off: Triple Therapy Matches DAPT in Acute Stenting with Thrombectomy

Background Patients undergoing intra‐ or extracranial stenting are typically placed on a dual antiplatelet therapy (DAPT) regimen to decrease the risk of in‐stent thrombosis. However, initiating DAPT in patients already on oral anticoagulants (OACs) is controversial due to the increased risk of hemorrhagic transformation. Studies have been done on patients with atrial fibrillation on OACs undergoing coronary stenting with subsequent DAPT initiation, but there are no corollaries for patients undergoing acute carotid or intra‐cranial stenting where the risk for hemorrhage or hemorrhagic transformation (HT) is higher. This retrospective cohort study aims to bridge that understanding and checked whether patients with acute ischemic stroke (AIS) requiring mechanical thrombectomy (MT) and stenting experienced different rates of adverse outcomes depending on whether they were on triple therapy with DAPT and OACs, or DAPT only. Methods A prospectively maintained endovascular database was searched for patients presenting with AIS who underwent MT with carotid or intra‐cranial stenting during the same procedural session from 2013 to 2025 at a comprehensive stroke center, and categorized by prior anticoagulation use. Demographics, manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admission NIHSS (National Institute of Health Stroke Scale) scores were compared. Safety and functional outcomes include HT, mass effect, mortality, symptomatic and asymptomatic intracranial hemorrhage, NIHSS at discharge, and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing variables were excluded from analysis of that variable. NIHSS at three months was omitted due to heavily skewed distribution. Results Of the 186 patients who met inclusion criteria, 63 were already on OACs, 68.25% of whom are male. There was a significant difference in rates of coronary artery disease (33.33% triple therapy cohort vs. 16.67% DAPT‐only cohort, p =0.01) and hyperlipidemia (68.25% triple therapy cohort vs. 54.17% DAPT‐only cohort , p =0.01); age of patients with mean age±SD of 70.98±11.37 triple therapy cohort vs 65.91±14.163 DAPT‐only cohort ( p =0.01); and NIHSS scores on admission with median IQR scores of 12 7‐17 in the triple therapy cohort group vs. 15 10‐21 in the DAPT‐only cohort ( p =0.02). None of the outcomes displayed any significant differences in the two groups. Conclusion In this single‐center retrospective cohort, patients on OAC undergoing MT with stenting did not experience increased hemorrhagic or functional complications when treated with triple therapy compared with DAPT alone. These findings suggest triple therapy may be safe in this setting, but prospective multicenter validation is warranted. image