Abstract T P100: Optimal Duration of Dual Antiplatelet Therapy for Symptomatic Intracranial Stenosis

Abstract

BACKGROUND: There is limited data on the optimal duration of dual antiplatelet therapy in combination with aggressive optimization of risk factors for secondary stroke prevention in patients with symptomatic intracranial stenosis. METHODS: Consecutive patients presenting to Emory University Hospital with high-grade (70-99%) symptomatic intracranial stenosis from January 1, 2011 to December 31, 2013 and evaluated within 30 days of the index event (stroke or TIA) were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the SAMMPRIS protocol; all patients were given an H2 blocker as gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n=227). RESULTS: Of 25 patients who met inclusion criteria, mean age was 65 +/- 14 years, 77% male, 58% white, 92% with hypertension, 100% with dyslipidemia, 15% with coronary artery disease, and 73% had stroke as their symptomatic event; baseline characteristics were similar between the Emory cohort and the SAMMPRIS cohort except for active smoking at the time of symptomatic event (Cohort 8%, SAMMPRIS 30%) and basilar site of symptomatic stenosis (Cohort 44%, SAMMPRIS 22%). Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and SAMMPRIS cohort. At 1 year, rates of stroke, myocardial infarction or vascular death were 0% in our cohort vs 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding occurred in only 1 (4%) patient who had gastrointestinal bleeding requiring transfusion while taking concomitant non-steroidal anti-inflammatory medication. CONCLUSIONS: A prolonged course of dual antiplatelet therapy with aspirin and clopidogrel for at least 12 months in combination with aggressive medical management based on the SAMMPRIS protocol may be associated with reduced rates of stroke, myocardial infarction, and vascular death compared to dual antiplatelet therapy for 3 months.