Dual Antiplatelet Therapy for Acute Ischemic Stroke

Recommended DAPT Regimens

• The American Heart Association recommends dual antiplatelet therapy with aspirin plus clopidogrel for 21 days in patients with minor ischemic stroke or high-risk TIA, followed by single antiplatelet therapy 1, 3
• For patients with minor ischemic stroke, the recommended loading dose is aspirin 160-325 mg + clopidogrel 300-600 mg, with a maintenance dose of aspirin 81 mg daily + clopidogrel 75 mg daily 1, 3

Important Implementation Guidelines

• The American College of Cardiology recommends initiating DAPT as early as possible, ideally within 12-24 hours of symptom onset, in patients with acute ischemic stroke 1, 3
• Intracranial hemorrhage must be excluded on neuroimaging before starting DAPT therapy 1, 3

Special Clinical Scenarios

• For patients with intracranial atherosclerotic stenosis, DAPT with aspirin and clopidogrel is recommended 1, 4
• For patients with embolic stroke of undetermined source, antiplatelet therapy is recommended rather than oral anticoagulants 1, 3

Long-Term Antiplatelet Therapy After DAPT

• The American Heart Association recommends continuing with single antiplatelet therapy using either aspirin 81 mg daily or clopidogrel 75 mg daily after completing the short-term DAPT course 1, 3
• For long-term secondary prevention in non-cardioembolic stroke, clopidogrel or aspirin/extended-release dipyridamole may be preferred over aspirin alone 5, 6, 7