- Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin given within 24 hours after high-risk transient ischaemic attack (TIA) or acute ischaemic stroke reduces the risk for subsequent stroke by 2% with few serious adverse events.
- Discontinuation of dual antiplatelet therapy within 21 days, and possibly as early as 10 days, of initiation is likely to maximise benefit and minimise harms.
Why this matters
- Current guidelines for the management of acute ischaemic stroke and TIA typically recommend single antiplatelet therapy, most commonly aspirin.
- 3 randomised controlled trials including 10,447 patients with acute minor ischaemic stroke or TIA attack met eligibility criteria after a search across electronic databases.
- Funding: None.
- Compared with aspirin alone, DAPT reduced the risk for any non-fatal recurrent stroke (relative risk [RR], 0.70; 95% CI, 0.61-0.80) and all recurrent stroke (RR, 0.71; 95% CI, 0.63-0.82).
- Pooled analysis showed that DAPT possibly increased the risk for moderate or major extracranial haemorrhage (RR, 1.71; 95% CI, 0.92-3.20).
- Kaplan-Meier curves up to days 10, 11 to 21 and 22 to 90 showed that DAPT reduced the risk for stroke in the first 10 days (OR, 0.64; 95% CI, 0.55-0.76); there was no appreciable additional benefit in days 22 to 90 (OR, 1.47; 95% CI, 0.84-2.56).
- Loading dose and treatment onset time differed among studies.