An Uninterrupted DOAC plus Single Antiplatelet Strategy for Carotid Artery Stenting in Patients with Atrial Fibrillation.

OBJECTIVE

Periprocedural antithrombotic management in patients with non-valvular atrial fibrillation (NVAF) undergoing carotid artery stenting (CAS) remains controversial. Although dual antiplatelet therapy is the standard regimen for CAS, its combination with a direct oral anticoagulant (DOAC) as triple therapy increases bleeding risk. On the other hand, interruption of DOAC therapy may increase thromboembolic risk. We evaluated the clinical outcomes and feasibility of an uninterrupted dual antithrombotic therapy (DAT) strategy consisting of a DOAC and single antiplatelet therapy (SAPT).

METHODS

We retrospectively reviewed a case series of 10 patients with NVAF treated between 2018 and 2025 who underwent CAS while continuing DOAC plus SAPT without interruption. In all cases, SAPT (clopidogrel, aspirin, or prasugrel) was initiated at least 2 weeks before the procedure. Platelet function was assessed using the VerifyNow system (Werfen, Bedford, MA, USA). We evaluated baseline clinical characteristics, antithrombotic regimens, platelet reactivity, procedural details, and periprocedural clinical outcomes.

RESULTS

The mean CHA2DS2-VASc and HAS-BLED scores were 4.4 ± 1.4 and 3.8 ± 1.0, respectively. CAS was successfully performed in all patients. One patient with elevated P2Y12 reaction units required the temporary periprocedural addition of cilostazol. No periprocedural hemorrhagic or thromboembolic complications occurred during the periprocedural period or within 3 months after CAS.

CONCLUSION

Uninterrupted DAT with a DOAC and SAPT may be a feasible periprocedural management strategy for CAS in patients with NVAF, without the need for DOAC interruption or triple therapy.