Dual antiplatelet therapy immediately after TIA or minor str
Patients with a minor ischemic stroke or high-risk transient ischemic attack (TIA) should start dual antiplatelet therapy with aspirin plus clopidogrel as soon as possible after the event, preferably within 24 hours, according to the recently published systemic review and meta-analysis in BMJ.

What is already known on this topic?
Current guidelines for the management of acute ischaemic stroke and transient ischaemic attack recommend antiplatelet therapy.

These guidelines typically provide strong recommendations for use of a single agent, most commonly aspirin.

What this study adds?
• Pooled data from three trials including more than 10 000 patients established a benefit of dual antiplatelet therapy started within 24 hours of presentation in reducing the absolute risk of recurrent stroke by about 2%.

• Serious extracranial bleeding in this setting is uncommon, and any increase with dual antiplatelet therapy is likely to be small.

• Stopping clopidogrel within 21 days, and possibly within 10 days, is likely to maintain the full benefits of dual antiplatelet therapy while minimising harms.


BMJ Rapid Recommendations
It can take years for new research evidence to filter into new treatment guidelines-in the meantime, many patients receive outdated care. That is why The BMJ is working with MAGIC, a non-profit research and innovation programme, to develop Rapid Recommendations. These accelerate evidence into practice to answer the questions that matter quickly and transparently through trustworthy recommendations.

Source: https://www.bmj.com/content/363/bmj.k5130
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