Administration of antithrombotic agents in neuroendovascular therapy is important to prevent periprocedural thromboembolic complications. Both anticoagulants that prevent red thrombi formed by flow stagnation in the catheter and antiplatelets that prevent white thrombi triggered by the implanted foreign body, such as coils and stents, are needed. With the progress of endovascular techniques and development of new devices, periprocedural antiplatelet therapy has been used more aggressively in recent years. Currently, the standard antiplatelet management in many neuroendovascular treatments is dual antiplatelet therapy. Perioperative antithrombotic therapy may reduce ischemic complications, but it presents the potential risk of hemorrhagic complications. Moreover, long-term dual therapy does not reduce the risk of stroke recurrence and is associated with an increased risk of major bleeding events. For patients at high risk for hemorrhagic complications, the physician should undertake measures, such as reducing the dose or discontinuing it early.