Work

Direct oral anticoagulant and antiplatelet therapy for extracranial neurovascular stenting in patients with atrial fibrillation

Year: 2025

Type: article

Abstract: BACKGROUND: Atrial fibrillation (AF) is a common comorbidity in patients with extracranial neurovascular disease. When these patients require interventional procedures, the optimal perioperative anticoagulation regimen remains unclear. This study evaluates the safety and efficacy of a perioperative antithrombotic strategy for non-valvular atrial fibrillation (NVAF) patients undergoing carotid artery stenting (CAS) or vertebral artery stenting (VAS). METHODS: We retrospectively analyzed clinical data from NVAF patients treated with CAS/VAS between January 2018 and June 2023. The pre-procedural regimen included aspirin (100 mg/day), clopidogrel (75 mg/day), and prophylactic low molecular weight heparin (LMWH). Post-procedural therapy combined a novel oral anticoagulant (NOAC) with a P2Y12 inhibitor. RESULTS: Thirty patients (71.3 ± 6.9 years; 93.3% male) achieved technical success. Complications included one hemorrhage and one unexplained cerebral embolism. No acute/subacute stent thrombosis or restenosis occurred within 3 months. CONCLUSIONS: Dual antithrombotic therapy (NOAC + P2Y12 inhibitor) post-procedure may balance efficacy and safety in NVAF patients undergoing CAS/VAS. Larger studies are needed for validation.

Source: BMC Neurology

DOI: 10.1186/s12883-025-04240-2