Background Dual antiplatelet therapy (DAPT) following stent-assisted coil (SAC) embolization increases the risk of ischemic and hemorrhagic complications. To evaluate the safety and efficacy of DAPT in treating acute ruptured aneurysms after SAC and analyze risk factors for poor clinical prognosis.Methods We retrospectively analyzed data from patients with aneurysmal subarachnoid hemorrhage (aSAH) between 1 May 2017 and 31 December 2021. Patients were divided into the SAC group and the non-SAC group (NSC). The SAC group received DAPT. We also compared modified Rankin Scale scores and the incidence of bleeding and ischemic complications. Additionally, we analyzed risk factors affecting clinical prognosis.Results A total of 2612 patients were included in the analysis: 1011 in the SAC group and 1601 in the NSC group. During hospitalization, there was no significant difference in bleeding and ischemic complications between the groups. Similarly, there was no statistically significant difference in clinical prognosis between the SAC and NSC groups at discharge and six months after discharge. Multivariate analysis indicated age, previous cerebral hemorrhage, posterior circulation aneurysm, multiple aneurysms, modified Fisher scale 3-4, and Glasgow Coma Scale (GCS) scores of 3-8 and 9-12 as risk factors for poor clinical prognosis after SAC.Conclusions DAPT after SAC for intracranial ruptured aneurysms was found to be safe and effective. Age, previous cerebral hemorrhage, posterior circulation aneurysm, multiple aneurysms, modified Fisher scale 3-4, and GCS scores of 3-12 were identified as risk factors for poor prognosis.