Optimal Duration of Dual Antiplatelet Therapy After Stent-assisted Coiling

NCT ID: NCT05257824

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

528 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-06-23

Study Completion Date

2025-12-02

Brief Summary

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Comparison of duration of dual antiplatelet therapy after stent-assisted coiling of unruptured intracranial aneurysms

Detailed Description

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The purpose of this study is to compare the incidence of thromboembolic and hemorrhagic complications between 1 and 18 months after stent-assisted coiling according to the duration of use of dual antiplatelet agents (6 months versus 12 months) after stent-assisted coiling of unruptured intracranial aneurysms to determine the optimal duration of use of dual antiplatelet agents.

Conditions

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Aneurysm Cerebral Endovascular Procedures

Keywords

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dual antiplatelet cerebral aneurysm coil embolization stent

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

1. short-term dual antiplatelet group: for 6 months
2. long-term dual antiplatelet group: for 12 months
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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short-term dual antiplatelet group

Patients with unruptured intracranial aneurysms received dual antiplatelet agents (100mg of aspirin and 75mg of clopidogrel) for at least five days before coil embolization. One day prior to coiling, aspirin reaction units (ARU) and P2Y12 reaction units (PRU) were measured using VerifyNow. Patients with proper aspirin and clopidogrel reaction units (ARU \< 550 and PRU 85 \~219) will be enrolled in this study. After stent-assisted coiling, dual antiplatelet treatment continued for 6 months; after that time, this therapy will be exchanged for daily oral 100mg of aspirin for 18 months after coiling

Group Type ACTIVE_COMPARATOR

Aspirin 100mg

Intervention Type DRUG

1. short-term dual antiplatelet: dual antiplatelet agents for 6 months
2. long-term dual antiplatelet: dual antiplatelet agents for 12 months

Clopidogrel 75mg

Intervention Type DRUG

1. short-term dual antiplatelet: dual antiplatelet agents for 6 months
2. long-term dual antiplatelet: dual antiplatelet agents for 12 months

long-term dual antiplatelet group

Patients with unruptured intracranial aneurysms received dual antiplatelet agents (100mg of aspirin and 75mg of clopidogrel) for at least five days before coil embolization. One day prior to coiling, aspirin reaction units (ARU) and P2Y12 reaction units (PRU) were measured using VerifyNow. Patients with proper aspirin and clopidogrel reaction units (ARU \< 550 and PRU 85 \~219) will be enrolled in this study. After stent-assisted coiling, dual antiplatelet treatment continued for 12 months; after that time, this therapy will be exchanged for daily oral 100mg of aspirin for 18 months after coiling.

Group Type EXPERIMENTAL

Aspirin 100mg

Intervention Type DRUG

1. short-term dual antiplatelet: dual antiplatelet agents for 6 months
2. long-term dual antiplatelet: dual antiplatelet agents for 12 months

Clopidogrel 75mg

Intervention Type DRUG

1. short-term dual antiplatelet: dual antiplatelet agents for 6 months
2. long-term dual antiplatelet: dual antiplatelet agents for 12 months

Interventions

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Aspirin 100mg

1. short-term dual antiplatelet: dual antiplatelet agents for 6 months
2. long-term dual antiplatelet: dual antiplatelet agents for 12 months

Intervention Type DRUG

Clopidogrel 75mg

1. short-term dual antiplatelet: dual antiplatelet agents for 6 months
2. long-term dual antiplatelet: dual antiplatelet agents for 12 months

Intervention Type DRUG

Other Intervention Names

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Aspirin protect Aspirin enteric coated Plavix Celavix Plavitor Pregrel Cloart Platless Pidogle Antipla Jgrel

Eligibility Criteria

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Inclusion Criteria

* subjects over 19 years old
* subjects with modified Rankin Scale (mRS) ≤ 2
* subjects with unruptured intracranial aneurysms
* subjects with appropriated aspirin and clopidogrel reaction units after dual antiplatelet preparation (100 mg of aspirin and 75 mg of clopidogrel) for at least 5 days before procedure \[measured using VerifyNow\]

1. aspirin reaction unit (ARU) \< 550
2. P2Y12 reaction unit (PRU): 85\~219
* subjects who agreed to this study (with informed consent)

Exclusion Criteria

* subjects with neurological deficits (mRS ≥ 3)
* subjects with an allergic reaction to antiplatelets (aspirin and clopidogrel) or contrast
* subjects with a high risk of hemorrhage such ICH or severe gastric ulceration
* subjects with coagulopathy
* subjects with thrombocytopenia (\<100,000/mm3)
* subjects with liver diseases (\> 100IU/L of aspartate aminotransferase or alanine aminotransferase)
* subjects with renal diseases (\> 2mg/dL of serum creatinine)
* subjects with underlying diseases that need to maintain dual antiplatelet drugs or anticoagulants.
* subjects with a high risk of strokes (atrial fibrillation, over 70% cerebral artery stenosis or cerebral artery occlusion, moyamoya disease, vascular malformations, etc)
* subjects with uncontrolled congestive heart failure or angina
* subjects with malignant tumors
* subjects with a positive pregnancy test (serum or urine)
* subjects who are unconscious at the time of diagnosis.
* subjects who are unable to complete the required follow-ups
* subjects with life-threatening diseases
* subjects with medical conditions with a life expectancy of less than two years
* subjects who are determined to be disqualified by researchers
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Pusan National University Yangsan Hospital

OTHER

Sponsor Role collaborator

Keimyung University Dongsan Medical Center

OTHER

Sponsor Role collaborator

Uijeongbu St. Mary's Hospital

UNKNOWN

Sponsor Role collaborator

Chungnam National University Sejong Hospital

OTHER

Sponsor Role collaborator

Soonchunhyang University Hospital

OTHER

Sponsor Role collaborator

Asan Medical Center

OTHER

Sponsor Role collaborator

Gangnam Severance Hospital, Yonsei University College of Medicine

UNKNOWN

Sponsor Role collaborator

Seoul National University Bundang Hospital

OTHER

Sponsor Role lead

Responsible Party

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Kwon Oki

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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O-Ki Kwon

Role: PRINCIPAL_INVESTIGATOR

Seoul National University Bundang Hospital

Locations

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Chungnam National University Sejong Hospital

Sejong, Chungcheongnam-do, South Korea

Site Status

Seoul National University Bundang Hospital

Seongnam-si, Gyeonggi-do, South Korea

Site Status

Pusan National University Yangsan Hospital

Yangsan, Gyeongsangnam-do, South Korea

Site Status

Keimyung University Dongsan Medical Center

Daegu, , South Korea

Site Status

Soonchunhyang University Seoul Hospital

Seoul, , South Korea

Site Status

Asan Medical Center

Seoul, , South Korea

Site Status

Yonsei University Gangnam Severance Hospital

Seoul, , South Korea

Site Status

Uijeongbu St. Mary's Hospital

Uijeongbu-si, , South Korea

Site Status

Countries

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South Korea

References

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UCAS Japan Investigators; Morita A, Kirino T, Hashi K, Aoki N, Fukuhara S, Hashimoto N, Nakayama T, Sakai M, Teramoto A, Tominari S, Yoshimoto T. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012 Jun 28;366(26):2474-82. doi: 10.1056/NEJMoa1113260.

Reference Type BACKGROUND
PMID: 22738097 (View on PubMed)

Hwang G, Kim JG, Song KS, Lee YJ, Villavicencio JB, Suroto NS, Park NM, Park SJ, Jeong EA, Kwon OK. Delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysm: characteristics and optimal duration of preventative dual antiplatelet therapy. Radiology. 2014 Oct;273(1):194-201. doi: 10.1148/radiol.14140070. Epub 2014 Jun 11.

Reference Type BACKGROUND
PMID: 24918960 (View on PubMed)

Hwang G, Huh W, Lee JS, Villavicencio JB, Villamor RB Jr, Ahn SY, Kim J, Chang JY, Park SJ, Park NM, Jeong EA, Kwon OK. Standard vs Modified Antiplatelet Preparation for Preventing Thromboembolic Events in Patients With High On-Treatment Platelet Reactivity Undergoing Coil Embolization for an Unruptured Intracranial Aneurysm: A Randomized Clinical Trial. JAMA Neurol. 2015 Jul;72(7):764-72. doi: 10.1001/jamaneurol.2015.0654.

Reference Type BACKGROUND
PMID: 26010803 (View on PubMed)

Kim CH, Hwang G, Kwon OK, Ban SP, Chinh ND, Tjahjadi M, Oh CW, Bang JS, Kim T. P2Y12 Reaction Units Threshold for Implementing Modified Antiplatelet Preparation in Coil Embolization of Unruptured Aneurysms: A Prospective Validation Study. Radiology. 2017 Feb;282(2):542-551. doi: 10.1148/radiol.2016160542. Epub 2016 Sep 2.

Reference Type BACKGROUND
PMID: 27603789 (View on PubMed)

Kim T, Kim CH, Kang SH, Ban SP, Kwon OK. Relevance of Antiplatelet Therapy Duration After Stent-Assisted Coil Embolization for Unruptured Intracranial Aneurysms. World Neurosurg. 2018 Aug;116:e699-e708. doi: 10.1016/j.wneu.2018.05.071. Epub 2018 May 17.

Reference Type BACKGROUND
PMID: 29778598 (View on PubMed)

Hwang G, Jung C, Park SQ, Kang HS, Lee SH, Oh CW, Chung YS, Han MH, Kwon OK. Thromboembolic complications of elective coil embolization of unruptured aneurysms: the effect of oral antiplatelet preparation on periprocedural thromboembolic complication. Neurosurgery. 2010 Sep;67(3):743-8; discussion 748. doi: 10.1227/01.NEU.0000374770.09140.FB.

Reference Type BACKGROUND
PMID: 20651627 (View on PubMed)

Almekhlafi MA, Al Sultan AS, Kuczynski AM, Brinjikji W, Menon BK, Hill MD, Goyal M. Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms. J Neurointerv Surg. 2020 Mar;12(3):298-302. doi: 10.1136/neurintsurg-2019-015173. Epub 2019 Sep 20.

Reference Type BACKGROUND
PMID: 31540948 (View on PubMed)

Other Identifiers

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B-2102-667-002

Identifier Type: -

Identifier Source: org_study_id