🧠💡 New data raises 🔍 about the optimal use of short-term dual antiplatelet therapy (DAPT) after ischemic stroke or TIA..
🩹 Key points..
- Short-term DAPT (aspirin + clopidogrel for 21 days) 🕐 reduces recurrent stroke risk 🎯, especially when started within 24 hours.
- Most evidence is for minor strokes (NIHSS ≤3) or high-risk TIAs (ABCD2 ≥4).
- 🆕 New study 📑 looks at starting DAPT within 72 hrs in pts with slightly worse symptoms (NIHSS ≤5).
- Results: 🛡️ 1 stroke prevented per 53 pts treated, but 🩸 moderate-severe bleeding in 1/200 pts.
⚠️ DAPT Guidance..
- Use in select cases: high-risk TIA or mild stroke (NIHSS ≤5).
- Avoid DAPT in severe strokes or pts on thrombolytics/anticoagulants. 🚫
- Start DAPT ASAP 🕐 but up to 72 hrs post-stroke if needed (e.g., delayed care).
- Typically, aspirin + clopidogrel. Consider a loading dose of clopidogrel (Plavix) 300 mg + aspirin 325 mg, then clopidogrel 75 mg/day + aspirin 81 mg/day.
💊 Ticagrelor (Brilique) + aspirin reduces stroke risk but may ⬆️ intracranial hemorrhage risk and must be taken BID. Plus, 💰 costs more and may cause dyspnea.
Stop 🛑 DAPT after 21 days (or 10 days for higher bleeding risk). Then switch to ONE long-term antiplatelet, usually aspirin 81 mg/day. 📋
References
- Gao Y, Chen W, Pan Y, et al. Dual Antiplatelet Treatment up to 72 Hours after Ischemic Stroke. N Engl J Med. 2023;389(26):2413-2424.
- Kim AS. Extending Dual Antiplatelet Therapy for TIA or Stroke. N Engl J Med. 2023;389(26):2478-2479.
- Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364-e467.
