Dual antiplatelet therapy with aspirin and clopidogrel
What is the role of dual antiplatelet therapy after high risk transient ischaemic attack or minor stroke? Specifically, does dual antiplatelet therapy with a combination of aspirin and clopidogrel lead to a greater reduction in recurrent stroke and death over the use of aspirin alone when given in the first 24 hours after a high-risk transient ischaemic attack or minor ischaemic stroke? An expert panel produced a strong recommendation for initiating dual antiplatelet therapy within 24 hours of the onset of symptoms, and for continuing it for 10-21 days. Current practice is typically to use a single drug.
What you need to know
People with high risk transient ischaemic attack or minor ischaemic stroke are at an increased risk of recurrent stroke and death
Aspirin and clopidogrel decrease this risk, even more so when used in combination
We make a strong recommendation for dual antiplatelet therapy (DAPT) with clopidogrel and aspirin to be started within 24 hours in patients who have had a high risk transient ischaemic attack or minor stroke
We make a strong recommendation for DAPT to be continued for 10-21 days, at which point patients should continue with single antiplatelet therapy
DAPT is not to be used for major stroke because of the increased risk of intracranial bleeding in these patients