Abstract 130: Antithrombotic Strategies After Carotid Stenting: DOAC With Single vs Dual Antiplatelet Therapy

Introduction Carotid artery stenting (CAS) requires dual antiplatelet therapy (DAPT) to prevent in‐stent thrombosis. Patients may also require anticoagulation for atrial fibrillation (AF) or thromboembolism but combining anticoagulation with DAPT increases bleeding risk. While DOAC + DAPT is often used in cardiology patients, its safety and efficacy are unknown in the CAS population. This study compared outcomes between DOAC + single antiplatelet therapy (SAPT) and DOAC + DAPT in CAS patients. Methods We retrospectively analyzed adults aged 50‐90 in the TriNetX database who underwent CAS and received a DOAC (apixaban, rivaroxaban, or edoxaban) with either SAPT (clopidogrel, ticagrelor, or prasugrel) or DAPT (clopidogrel, ticagrelor, or prasugrel plus aspirin) between 2005 and 2025. Using the Trinet X analysis tool, pre‐CAS demographics and comorbidities within the prior year were compared. Propensity score matching (PSM) balanced groups, and regression analysis evaluated a composite cerebrovascular outcome of cerebral infarction, carotid occlusion/stenosis, or intracerebral hemorrhage within 1 year of CAS. Results Seventy patients received DOAC + SAPT, and 240 received DOAC + DAPT. Mean age was similar (78 vs. 77). SAPT group had higher rates of cardiac arrest (15% vs. 5%), non‐atrial fibrillation/flutter cardiac arrhythmias (50% vs. 36%), pulmonary embolism (15% vs. 5%), esophagogastric diseases (59% vs. 42%), and Systemic neoplasms (58% vs. 28%). See table for other comorbidities. After PSM (58 per group), the composite outcome occurred in 70.7% of SAPT vs. 74.1% of DAPT patients (risk difference −0.034; 95% CI −0.197 to 0.128; p=0.678; risk ratio 0.95, 95% CI 0.76‐1.19). See figure. Conclusion In CAS patients requiring anticoagulation, DOAC + SAPT yielded 1‐year composite cerebrovascular outcomes comparable to DOAC + DAPT, despite a higher comorbidity burden. SAPT with DOAC may represent a safe alternative for patients at high bleeding risk, if larger prospective studies confirm this finding. image image