Abstract Details

Title Clopidogrel Versus Ticagrelor in Dual Antiplatelet Therapy for Intracranial Aneurysm Patients Undergoing Neuroendovascular Treatment: A Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P10 - Poster Session 10 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-023

Objective We aimed to investigate the safety and effectiveness of administering clopidogrel versus ticagrelor in addition to aspirin as a part of dual antiplatlete therapy (DAPT) regimen for unanticipated or planned neuroendovascular operations.

Background Patients with cerebral aneurysms often undergo neurointerventional treatments involving stent implantation or flow diversion. These treatment options are associated with high risk of thromboembolic complications which shows the importance of the use of DAPT. However, there is some conflict regarding the use of ticagrelor or clopidogrel in addition to aspirin in DAPT.

Design/Methods We searched PubMed, Web of Science, and Scopus for comparative studies that fit the eligibility criteria including observational studies and randomized controlled trials up to August 2023. We excluded reviews, case reports, and meta-analyses. The analysis was performed using a fixed effect model since no or minimal heterogeneity was present. We conducted pooled analysis of odds ratio (OR) at confidence interval 95% and p-value of 0.05.

Results The search strategy and screening yielded a total of 13 eligible articles. There was no difference between clopidogrel and ticagrelor in thromboembolic complications, hemorrhagic complications, stroke, ischemic stroke, stent thrombosis, modified Rankin scale (mRs) 0-2 and all-cause mortality (OR= 0.92, 95% CI [0.73, 1.16], p=0.46), (OR= 1.06 .95% CI : 0.82–1.36), (OR= 1.06 ,95% CI [0.72, 1.57], p=0.76), (OR= 1.06, 95% CI [0.67, 1.69], p=0.79), (OR= 0.88 ,95% CI [0.46, 1.71], p=0.71),(OR=0.86, 95% CI 0.51 to 1.45; P=0.56), and (OR= 1.01 with 95% CI [0.59, 1.73], p=0.97), respectively. The overall odds ratio between the clopidogrel and ticagrelor in mRs worsening favored ticagrelor (OR= 0.52, 95% CI [0.32, 0.83], p=0.007).

Conclusions Comparable results were obtained regarding safety and efficacy outcomes between both drugs as used in DAPT regimens. Therefore, clopidogrel can be used as first-line according to the recommended guidelines, with the use of ticagrelor as an alternative for patients with inadequate response to clopidogrel due to the presence of polymorphism in CYP450 enzymes that activate clopidogrel to prevent the risk of thrombosis.

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Authors/Disclosures
Ahmed Negida, MD, PhD (Virginia Commonwealth University) PRESENTER	Dr. Negida has nothing to disclose.
Mostafa El Din Moawad	Mostafa El Din Moawad has nothing to disclose.
Ibraheem Alkhawaldeh	Ibraheem Alkhawaldeh has nothing to disclose.
Abdulrahman Sharaf	No disclosure on file
Sumaya Alsalah	No disclosure on file
Mohamed Smail Aissani	No disclosure on file
Mona Elsakka	Mona Elsakka has nothing to disclose.
Ibrahim Serag, MD	Dr. Serag has nothing to disclose.
Osama Bisht	No disclosure on file

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