From the Research
Introduction to Dual Antiplatelet Therapy in Acute Ischemic Strokes
Dual antiplatelet therapy (DAPT) has been explored as a treatment option for acute ischemic strokes, particularly for minor, non-disabling strokes. The role of DAPT in this context is to prevent recurrent ischemic strokes by inhibiting platelet aggregation.
Efficacy of DAPT in Acute Ischemic Strokes
Studies have shown that DAPT is effective in reducing the risk of recurrent ischemic strokes in patients with acute ischemic strokes or transient ischemic attacks (TIAs) [ 1, 2,3,4,5 ]. The combination of aspirin and ticagrelor, or aspirin and clopidogrel, has been found to be superior to aspirin alone in preventing recurrent ischemic strokes [ 1 ].
Safety of DAPT in Acute Ischemic Strokes
While DAPT is effective in reducing the risk of recurrent ischemic strokes, it also increases the risk of major bleeding [ 1, 5 ]. However, the risk of bleeding is generally considered to be acceptable, especially when the treatment is limited to a short duration, such as 30 days 5.
Treatment Regimens and Duration
The optimal treatment regimen and duration of DAPT for acute ischemic strokes are still being debated. However, the combination of aspirin and ticagrelor, or aspirin and clopidogrel, is commonly used [ 1, 2,3,4,5 ]. The duration of treatment is typically limited to 30 days, although some studies have explored longer treatment durations 5.
Dosing Information
The dosing information for DAPT in acute ischemic strokes is as follows:
- Aspirin: 81-100 mg daily
- Ticagrelor: 90 mg twice daily
- Clopidogrel: 75 mg daily
Patient Selection
DAPT is generally recommended for patients with acute ischemic strokes or TIAs who are at high risk of recurrent stroke [ 1, 2,3,4,5 ]. Patients with large artery atherosclerosis, intracranial arterial stenosis, or other high-risk features may benefit from DAPT 2, 4.
Caveats and Considerations
While DAPT is effective in reducing the risk of recurrent ischemic strokes, it is not without risks. Patients should be carefully selected and monitored for signs of bleeding or other adverse effects [ 1, 5 ]. The treatment regimen and duration should be individualized based on the patient's risk factors and medical history.