From the Research
For vertebral artery dissection, patients typically should be on dual antiplatelet therapy (DAPT) for 3-6 months. The most common regimen consists of aspirin 81-325 mg daily plus clopidogrel 75 mg daily 1. After this initial period, patients usually transition to single antiplatelet therapy (typically aspirin alone) for long-term secondary stroke prevention. However, treatment duration should be individualized based on follow-up imaging showing healing of the dissection, patient-specific bleeding risks, and clinical response. Some patients with persistent dissection or high-risk features may require longer DAPT courses. The rationale for DAPT is to prevent thromboembolic complications from the dissection, as the damaged arterial wall can promote platelet aggregation and thrombus formation. While anticoagulation with warfarin was historically used, current evidence suggests that antiplatelet therapy is equally effective with potentially lower bleeding risk 2. Regular clinical follow-up and repeat vascular imaging at 3-6 months are important to assess healing and guide therapy duration.
Key considerations for DAPT duration include:
- Patient-specific bleeding risks
- Clinical response to treatment
- Follow-up imaging showing healing of the dissection
- Presence of high-risk features or persistent dissection
The optimal duration of DAPT may vary depending on individual patient factors, and treatment should be tailored to balance the risks of thromboembolic complications and bleeding events 3. A recent meta-analysis found no significant differences between anticoagulant therapy and antiplatelet therapy for the treatment of carotid and vertebral artery dissections, supporting the use of antiplatelet therapy as a first-line treatment option 2.