Document resource
Background Clopidogrel (CPG)-based dual antiplatelet therapy (DAPT) is widely used prior to endovascular treatment of intracranial aneurysms to prevent procedural thromboembolic complications (TECs). Recently, newer-generation P2Y12 inhibitors - prasugrel and ticagrelor (PSG/TCG) - have emerged as potential alternatives. This meta-analysis aimed to evaluate the utility of PSG and TCG as first-line agents for DAPT by directly comparing their safety and efficacy with conventional CPG-based therapy.Method Relevant studies were extracted from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials by two independent reviewers. A random-effects model was used to compare the risk of TECs and hemorrhagic complications (HECs) between PSG/TCG-based and CPG-based DAPT, expressed as risk ratios (RRs) with 95% confidence intervals (CIs). Subgroup analyses were performed to compare platelet reactivity, measured by platelet reaction unit (PRU) values, between the two groups.Results Six studies encompassing 1,071 patients were included. Compared with CPG-based DAPT, PSG/TCG-based DAPT was associated with a significantly lower risk of TECs (RR, 0.59; 95% CI, 0.35-0.98; p = 0.04) without a corresponding increase in HECs. Subgroup analysis demonstrated significantly lower PRU values in the PSG/TCG compared with the CPG group (p = 0.01).Conclusion This meta-analysis suggests that PSG/TCG-based DAPT offers superior thromboembolic protection without increased hemorrhagic risk and may be considered a preferred option, not merely an alternative, to CPG-based DAPT in the perioperative management of intracranial aneurysms undergoing endovascular intervention.Disclosures Y. Cho: None.