Duration of Benefit for Dual Antiplatelet Therapy After Mild Ischemic Stroke or Transient Ischemic Attack

The INSPIRES trial (NEJM JW Neurol Jan 8 2024 and N Engl J Med 2023; 389:2413) expanded the time window for short-term dual antiplatelet therapy (DAPT) with clopidogrel-aspirin to 72 hours after symptom onset of mild ischemic stroke or high-risk transient ischemic attack (TIA) of presumed atherosclerotic etiology. In the partially industry-supported, randomized trial, DAPT reduced the risk for stroke (ischemic or hemorrhagic) but increased the risk for moderate-to-severe bleeding compared with aspirin alone. However, a direct assessment of the potential tradeoffs of benefits and risks, including the optimal duration of treatment that might best balance these factors, was not done. Therefore, this secondary analysis of the trial focused on t…