From the Guidelines
Dual Antiplatelet Therapy (DAPT) Duration after Acute Ischemic Stroke (AIS)
The recommended duration of DAPT after AIS is typically 21 days for patients with minor ischemic stroke or high-risk TIA, consisting of a combination of aspirin and clopidogrel or another P2Y12 inhibitor such as ticagrelor 1, 2.
- After the initial 21-day period, lifelong aspirin monotherapy is generally recommended for secondary stroke prevention 2.
- However, in certain cases, such as those with a high risk of recurrent stroke, extended DAPT may be considered for up to 90 days 3, 4.
- The choice of DAPT regimen, including the use of aspirin, clopidogrel, or ticagrelor, should be individualized based on patient-specific factors, such as the risk of recurrent stroke and bleeding 1, 2.
- It is essential to weigh the benefits of DAPT against the potential risks, including bleeding, and to closely monitor patients for any adverse effects 3, 4.
- The optimal duration of DAPT to maximize the risk-benefit ratio is still a topic of ongoing research, and additional studies are needed to determine the best approach for individual patients 3, 4.
From the Research
DAPT Duration After AIS
The recommended duration of Dual Antiplatelet Therapy (DAPT) after Acute Ischemic Stroke (AIS) varies depending on the patient's condition and stroke subtype.
- For patients with minor acute non-cardioembolic stroke or high-risk transient ischemic attack (TIA), short-term DAPT with aspirin and clopidogrel or ticagrelor for 21-30 days is more effective than single antiplatelet therapy (SAPT) in preventing recurrent stroke 5, 6, 7, 8, 9.
- However, prolonged use of DAPT is associated with a higher risk of hemorrhage without reduction in stroke recurrence than SAPT 5, 7.
- For patients with large vessel intracranial atherosclerotic disease, DAPT for 90 days, followed by aspirin monotherapy, is suitable for secondary stroke prevention 5.
- The choice of antiplatelet therapy should be individualized based on the stroke characteristics, time from symptom onset, and patient-specific predisposition to develop hemorrhagic complications 6.
Key Considerations
- The benefit of DAPT in preventing recurrent stroke is most pronounced in the short term, while the bleeding risk remains high during the extended duration of therapy 5, 8, 9.
- Patients with symptomatic intracranial stenosis may benefit from aggressive medical management in addition to dual antiplatelet therapy up to 90 days 6.
- The selection of appropriate antiplatelet therapy should also be based on compliance, drug tolerance, or resistance 7.