Guidelines Recommend Dual Antiplatelet Therapy Immediately After TIA or Minor Stroke

By Kelly Young

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM

Patients with a minor ischemic stroke or high-risk transient ischemic attack (TIA) should start dual antiplatelet therapy with aspirin plus clopidogrel as soon as possible after the event, preferably within 24 hours, according to a new BMJ Rapid Recommendations article.

The guidelines make a strong recommendation that dual therapy is preferred over aspirin alone given that there is a lower risk for recurrent stroke and functional disability with dual therapy.

The guideline committee also makes a strong recommendation in favor of a shorter duration of dual therapy (10–21 days, as opposed to 22–90 days). However, most patients should probably continue to take a single antiplatelet, often aspirin, indefinitely. If a patient's stroke work-up reveals an indication for anticoagulation (e.g., atrial fibrillation), patients should switch from antiplatelet therapy to anticoagulation.

Dual therapy shouldn't be used in patients with a major stroke because of increased risk for intracranial bleeding.

Dr. Seemant Chaturvedi of NEJM Journal Watch Neurology comments: "This meta-analysis and new guideline reinforce that short-term (up to 3 weeks) dual antiplatelet therapy with aspirin plus clopidogrel may be beneficial for patients with TIA or minor stroke."