Abstract
Abstract DP310: Dual Antiplatelet versus Anticoagulant-Plus-Antiplatelet Therapy in Symptomatic Intracranial Atherosclerosis: A Multicenter Comparative Study
Stroke (1970), Vol.57(Suppl_1)
02/2026
DOI: 10.1161/str.57.suppl_1.DP310
Abstract
Introduction: Intracranial atherosclerosis (ICAS) is a leading cause of ischemic stroke (IS) worldwide and carries a high risk of recurrence. Current guidelines favor 90 days of dual antiplatelet therapy (DAPT) for severe symptomatic ICAS, but recurrence remain high. Limited data suggest possible benefit of single antiplatelet plus anticoagulation (SAPT+AC). We compared the effectiveness and safety of DAPT versus SAPT+AC. We hypothesized that DAPT would lower 90-day recurrent IS risk without significantly increasing bleeding.
Methods: This substudy of the Biomarkers and Recurrence Risk in Symptomatic Intracranial Arterial Stenosis (BIORISK-ICAS) included patients from 35 centers (Jan 2019-Jun 2024) with symptomatic 50-99% ICAS in the intracranial internal carotid, vertebral, basilar, or M1 segment of the MCA, presenting ≤72 hours from last known well. The primary efficacy outcome was recurrent IS in the same vascular territory at 90 days; the primary safety outcome was severe bleeding (symptomatic intracranial hemorrhage or major extracranial bleeding). Categorical variables were compared using χ2 and continuous variables with the Student's t test; multivariable Cox regression adjusted for key covariates.
Results: Of 2050 BIORISK-ICAS patients, 1658 met criteria (DAPT n=1499; SAPT+AC n=159). Mean age was 67 vs. 73 years, and 44% were women. At 90 days, recurrent IS occurred in 121 DAPT patients (8.07%) vs. 13 SAPT+AC patients (8.17%); unadjusted HR 0.83 (95% CI, 0.50-1.36; p=0.46). After adjustment for age, diabetes, coronary heart disease, atrial fibrillation, active smoking, and borderzone infarct, the adjusted HR was 0.99 (95% CI, 0.52-1.86; p=0.97). Severe bleeding occurred in 34 DAPT patients (2.26%) and 5 SAPT+AC patients (3.14%); unadjusted HR 0.79 (95% CI, 0.28-1.85; p=0.50), adjusted HR 0.66 (95% CI, 0.21-2.09; p=0.47).
Conclusions: In patients with symptomatic ICAS, DAPT and SAPT+AC were associated with similar risks of 90-day recurrent ischemic stroke and severe bleeding. Well-powered randomized trials are needed to determine the optimal antithrombotic regimen in this high-risk population.
Details
- Title: Subtitle
- Abstract DP310: Dual Antiplatelet versus Anticoagulant-Plus-Antiplatelet Therapy in Symptomatic Intracranial Atherosclerosis: A Multicenter Comparative Study
- Creators
- Muhammad Aemaz Ur Rehman - University of Alabama at BirminghamFarhan Khan - Brown UniversityShadi Yaghi - Brown UniversitySami Al Kasab - Medical University of South CarolinaAhmad Abu Qdais - MUSC, Johns Island, South Carolina, United StatesSridhara Yaddanapudi - University of Maryland, BaltimoreSabiha Sultana - University of Maryland, BaltimoreMuhib Khan - Mayo ClinicMaarij Malik - Mayo ClinicJames Klaas - Mayo ClinicChristopher Leon Guerrero - Atrium Health, North Carolina, Charlotte, North Carolina, United StatesFaddi Saleh Velez - University of OklahomaCameron Owens - University of OklahomaCamila Pinto - University of OklahomaMargy McCullough-Hicks - University of MinnesotaDawson Cooper - University of MinnesotaAbhiram Parameswaran Pillai - University of MinnesotaPraveen Hariharan - University of MinnesotaShaista Alam - Thomas Jefferson University HospitalMirjam Heldner - University Hospital of BernKateryna Antonenko - University Hospital of BernWilliam Almiri - University Hospital of BernAaron Rothstein - University of PennsylvaniaBalaji Krishnaiah - University of Tennessee at KnoxvilleCheran Elangovan - University of Tennessee Health Science CenterAyush Agarwal - All India Institute of Medical SciencesMichele Romoli - Ospedale “M. Bufalini” di CesenaMarrone Nicola - Ospedale “M. Bufalini” di CesenaStefano Vozzi - Ospedale “M. Bufalini” di CesenaMalik Ghannam - University of IowaMahmoud Dibas - University of IowaJoao Pedro Marto - Hospital de Egas MonizMohammad AlMajali - Mercy St. Vincent Medical CenterAlexis Simpkins - Cedars-Sinai Medical CenterDiana Aguiar De Sousa - Lisbon Central University Hospital, Lisboa, PortugalMafalda Soares - Unidade Local de Saúde de São JoséAmanda Lima - University of North Carolina and Faculdade de Medicina da Universidade de Lisboa, Portugal, PortugalJames Siegler - University of ChicagoArgyro Tountopoulou - National and Kapodistrian University of AthensSOFIA Vasilopoulou - National and Kapodistrian University of AthensAdam de Havenon - Yale UniversityNils Henninger - UMass Memorial Medical CenterJohanna Helenius - University of Massachusetts Chan Medical SchoolMohammad Khasawneh - Washington University in St. LouisPiers Klein - Boston UniversityLiqi Shu - Brown UniversityPooja Khatri - Yale UniversityThanh Nguyen - Boston UniversityDavid Liebeskind - UCLA HealthEkaterina Bakradze - University of Alabama at Birmingham
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.57(Suppl_1)
- DOI
- 10.1161/str.57.suppl_1.DP310
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Publisher
- Lippincott Williams & Wilkins
- Language
- English
- Date published
- 02/2026
- Academic Unit
- Neurology
- Record Identifier
- 9985132202202771
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