This narrative review synthesizes published evidence regarding antiplatelet therapy strategies used during coil embolization of ruptured intracranial aneurysms, with particular emphasis on coil-only treatment and distinctions between coil-only and device-assisted procedures. The available literature suggests that antiplatelet therapy can reduce periprocedural thromboembolic complications, particularly in selected coil-only cases; however, evidence for consistent benefit in delayed cerebral ischemia, functional outcomes, or long-term recovery remains limited and heterogeneous. Importantly, findings from stent-assisted or flow-diverter-treated cohorts should not be directly extrapolated to coil-only procedures – antiplatelet therapy in device-assisted treatment is largely driven by implant-related thrombogenicity. The current evidence base is limited by retrospective study designs, single-center cohorts, heterogeneous treatment protocols, and inconsistent endpoint definitions. At present, no standardized antiplatelet regimen can be recommended for routine use in coil-only aneurysmal subarachnoid hemorrhage. Ongoing randomized studies, including the ASTOP trial, may help clarify the benefit-risk balance and determine whether a more evidence-based, procedure-specific antiplatelet strategy can be established.

Keywords: acetylsalicylic acid, antiplatelet therapy, intracranial aneurysm, Neurosurgery, Subarachnoid Hemorrhage