European Stroke Organisation expedited recommendation for the use of short-term dual antiplatelet therapy early after minor stroke and high-risk TIA.

Áine Merwick,Martin Dennis,Alastair Webb,Ana Catarina Fonseca,Julia Ferrari,Jesse Dawson

doi:10.1177/23969873211027006

Abstract

Prevention of early recurrent ischaemic stroke remains a priority in people with TIA or ischaemic stroke. A number of trials have recently been completed assessing the efficacy of short-term dual antiplatelet therapy (DAPT) versus single antiplatelet therapy early after minor or moderate stroke or high-risk TIA. We present an Expedited Recommendation for use of dual antiplatelet therapy early after ischaemic stroke and TIA on behalf of the ESO Guideline Board. We make a strong recommendation based on high quality of evidence for use of 21-days of dual antiplatelet therapy with aspirin and clopidogrel in people with a non-cardioembolic minor ischaemic stroke or high-risk TIA in the past 24 hours. We make a weak recommendation based on moderate quality evidence for 30-days of dual antiplatelet therapy with aspirin and ticagrelor in people with non-cardioembolic mild to moderate ischaemic stroke or high-risk TIA in the past 24 hours.

Highlights

Prevention of early recurrent ischaemic stroke remains a priority in people with TIA or ischaemic stroke
Minor ischaemic stroke was defined as NIHSS of 3 or less in the POINT and CHANCE trials and high-risk TIA as an ABCD2 score of 4 or more
Significantly reduced the risk of ischaemic stroke at 90 days (RR 0.70, 95% CI 0.61 to 0.81, I2 1⁄4 0%, absolute reduction 2.6%, high quality evidence, n 1⁄4 2 trials, 10051 participants)

Summary

Introduction

Prevention of early recurrent ischaemic stroke remains a priority in people with TIA or ischaemic stroke. A number of trials have recently been completed assessing the efficacy of short-term dual antiplatelet therapy (DAPT) versus single antiplatelet therapy early after minor or moderate stroke and high-risk TIA. The role of dual antiplatelet treatment will be considered in both the European Stroke Organisation’s guidelines for management of TIA and guidelines for secondary prevention of ischaemic stroke, yet their use is rapidly increasing. In advance of their publication, we present an Expedited Recommendation for use of dual antiplatelet therapy early after minor ischaemic stroke and TIA on behalf of the ESO Guideline Board. We considered evidence for use of DAPT early after minor or moderate ischaemic stroke and high-risk TIA. We considered DAPT with clopidogrel and aspirin separately from DAPT with ticagrelor and aspirin

Methods

Summary of current evidence

Findings

Ethical approval