Abstract 121: Triple Therapy: An Inexpensive, Safe, and Effective Regimen of Heparin, Aspirin and Clopidogrel in Managing Large or Medium Intracranial Vessel Occlusions in Acute Ischemic Stroke Patients Ineligible for Intravenous Thrombolytics and Unable to Undergo Endovascular Thrombectomy

Background Endovascular thrombectomy (EVT) has transformed the management of acute ischemic stroke but remains inaccessible to many patients due to anatomical, clinical, or logistical limitations. This retrospective, single‐center study evaluates the safety and efficacy of “Triple Therapy" — a regimen of heparin, aspirin, and clopidogrel — in acute ischemic stroke patients with intracranial occlusions who had minor neurological deficits and were ineligible for intravenous thrombolytics or EVT. Methods This retrospective single‐center study analyzed 47 consecutive eligible patients, with 25 patients receiving Triple Therapy and 22 undergoing EVT. Primary safety outcomes included symptomatic intracranial hemorrhage, any intracranial hemorrhage, and extracranial hemorrhage within 30 days. Efficacy outcomes included NIH Stroke Scale (NIHSS) at 72 hours, recanalization, length of hospital and ICU stay, and modified Rankin Scale (mRS) at discharge. Results Triple Therapy demonstrated a favorable safety profile, with no significant differences in hemorrhagic complications compared to EVT. Although EVT was independently associated with significantly higher rates of complete recanalization (OR 8.00, 95% CI 2.06‐31.03, p=0.003), both groups showed comparable clinical outcomes, including change in NIHSS, length of hospital stay, and mRS at discharge. A potential selection bias was not excluded given the presentation NIHSS for patients in Triple Therapy was lower than for patients who underwent EVT. Conclusions These findings suggest that Triple Therapy may provide an inexpensive and effective option for managing select ischemic stroke patients with large or medium intracranial vessel occlusions with minor neurological deficits who are ineligible for intravenous thrombolytics of EVT, especially in resource‐limited settings. Further prospective studies are needed to validate its role and optimize protocols for integrating this approach into clinical practice.