Murphy SJX, et al. - Given the high risk of vascular events among patients with carotid stenosis despite antiplatelet therapy, researchers comprehensively collated data on prescribed antiplatelet regimens from trials to guide optimal therapy in this population. In line with the current PRISMA guidelines, they identified 25 eligible studies for inclusion.

According to data from one randomized controlled trial, despite noting no significantly different benefit with aspirin vs placebo use in asymptomatic carotid stenosis, it is still reasonable to recommend aspirin (81–325 mg daily) for prevention of vascular events in this patient population. Compared with higher doses (> 650 mg daily), low-to-medium dose aspirin (81–325 mg daily) offered superior recurrent vascular event prevention in patients undergoing endarterectomy. Aspirin 81–325 mg daily was supported as peri-procedural treatment for asymptomatic and symptomatic patients, according to data from endovascular treatment (EVT) trials. In one pilot trial, using peri-procedural aspirin–clopidogrel in patients undergoing EVT appeared safe. For patients with ≥ 50% symptomatic carotid stenosis, equal efficacy was evident with short-term aspirin–dipyridamole or aspirin–clopidogrel treatments at reducing micro-embolic signals on transcranial Doppler ultrasound. For patients with symptomatic moderate–severe carotid stenosis, the evidence did not clearly support using routine aspirin–clopidogrel combination therapy for reducing the risk of recurrent clinical ischemic events.