Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

Author/s: 
Reed A.C., Hao, Qiukui, Guyatt, Gordon H., O’Donnell, Martin, Lytvyn, Lyubov, Heen, Anja Fog, Agoritsas, Thomas, Vandvik, Per O., Gorthi, Sankar P., Fisch, Loraine, Jusufovic, Mirza, Muller, Jennifer, Booth, Brenda, Horton, Eleanor, Fraiz, Auxiliadora, Siemieniuk, Jillian, Fobuzi, Awah C., Katragunta, Neelima, Rochwerg, Bram, Prasad, Kameshwar
Date Added: 
January 6, 2019
Journal/Publication: 
BMJ
Publisher: 
BMJ Publishing Group Ltd
Publication Date: 
December 18, 2018
Type: 
Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines
Format: 
Article
DOI (1): 
10.1136/bmj.k5130
PMID (1): 
30563885

RPR Commentary

This expert panel has issued a strong recommendation for initiating dual antiplatelet therapy (e.g. aspirin plus clopidogrel) within 24 hours of the onset of symptoms of a high-risk TIA or minor ischemic stroke based upon evidence from a recent large meta-analysis.

Abstract

What is the role of dual antiplatelet therapy after high risk transient ischaemic attack or minor stroke? Specifically, does dual antiplatelet therapy with a combination of aspirin and clopidogrel lead to a greater reduction in recurrent stroke and death over the use of aspirin alone when given in the first 24 hours after a high risk transient ischaemic attack or minor ischaemic stroke? An expert panel produced a strong recommendation for initiating dual antiplatelet therapy within 24 hours of the onset of symptoms, and for continuing it for 10-21 days. Current practice is typically to use a single drug.

Text Availability

Commercial full text (fees may apply)