Antiplatelet therapy for transient ischaemic attacks and acute minor strokes: current best practice and future

Chamila Mettananda

doi:10.4038/jccp.v52i1.7898

Abstract

In patients presenting with transient ischaemic attacks and acute minor noncardioembolic ischemic strokes (NIHSS score ≤3) who did not receive intravenous alteplase, treatment with dual antiplatelet therapy with aspirin and clopidogrel, started within 24 hours of symptom onset and continued for 21 days is effective in reducing a recurrent ischemic stroke up to 90 days from the symptom onset. However, as the long-term risk of major disabling bleeding with aspirin-based antiplatelet treatment is higher in patients aged 75 years or older, routine co-prescription of proton pump inhibitor should be encouraged.

Highlights

A significant percentage (15-26%) of strokes are preceded by transient ischaemic attacks (TIA) or minor strokes.[1]
Patients presenting with transient ischaemic attacks and acute minor ischemic strokes should receive dual antiplatelet therapy with aspirin and clopidogrel for 21 days
The CHANCE (Clopidogrel with aspirin in acute minor stroke or transient ischaemic attack) trial studied aspirin vs aspirin and clopidogrel combination administered within 24 and continued for 21 days following TIA or minor stroke and demonstrated that aspirin and clopidogrel combination was more effective in reducing recurrent strokes at 90 days without a significant increase in bleeding risk.[21]