Short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm: a meta-analysis

Nowadays endovascular therapy has become the first line treatment for the management of patients with un-ruptured intracranial aneurysms. However, the risk of thromboembolic events secondary to the use of intracranial stents is a major concern. The use of anti-platelet agents following this minimally invasive procedure is vital. In this analysis, we aimed to show the short term clinical outcomes associated with the use of ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm. Online electronic databases were searched for studies comparing ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm. Short term clinical outcomes (≤ 6 months) including ischemic and hemorrhagic stroke, mortality, major and minor bleeding events were considered the endpoints. Revman software was used to analyze data and risk ratios (RR) with 95% confidence intervals (CI) were used to represent the results. A total number of 1162 participants were included in this analysis. Five hundred and fifty eight (558) participants were treated with ticagrelor + aspirin whereas 604 participants were treated with clopidogrel + aspirin. Our results showed both ticagrelor and clopidogrel in combination with aspirin to be associated with a similar risk of ischemic stroke (RR: 0.66, 95% CI: 0.38 – 1.15; P = 0.15), hemorrhagic stroke (RR: 1.01, 95% CI: 0.28 – 3.60; P = 0.99), mortality (RR: 1.01, 95% CI: 0.33 – 3.11; P = 0.98), major bleeding (RR: 0.94, 95% CI: 0.30 – 2.94; P = 0.92) and minor bleeding (RR: 0.36, 95% CI: 0.06 – 1.97; P = 0.24). The short term clinical outcomes associated with ticagrelor + aspirin versus clopidogrel + aspirin following endovascular therapy for un-ruptured cerebral aneurysm were not significantly different. Both anti-platelet regimens were equally effective following endovascular therapy for un-ruptured cerebral aneurysm during this short term follow-up. However, due to the extraction of data from observational studies as well as a limited number of participants, this hypothesis should be confirmed in larger studies.