43
4.8. Antiplatelet Treatment
COR LOE
Recommendations
Early Secondary Prevention (cont'd)
3: Harm B-R
10. In patients with noncardioembolic ischemic stroke, treatment
with triple antiplatelet therapy (aspirin and clopidogrel and
dipyridamole) for secondary stroke prevention should not be
administered due to increased risk of bleeding.
3: Harm B-NR
11. In patients with ischemic stroke and AF without active CAD
or recent intravascular stent, the routine addition of antiplatelet
therapy to oral anticoagulation is potentially harmful because
of increased bleeding risk and is not recommended.
Dual Antiplatelet erapy for Minor AIS and High-Risk TIA
1 A
12. In patients with minor (NIHSS score ≤3) noncardioembolic
AIS or high-risk TIA (ABCD2 score ≥4) who did not receive
IVT, DAPT (aspirin and clopidogrel with loading dose of
clopidogrel) should be initiated early (within 24 hours after
symptom onset) and continued for 21 days, followed by
single antiplatelet therapy (SAPT) to reduce the 90-day risk
of recurrent ischemic stroke.
2b B-R
13. In patients with recent (<24 hours) minor (NIHSS score ≤5)
noncardioembolic AIS or high-risk TIA (ABCD2 score ≥6
or symptomatic intracranial or extracranial ≥50% stenosis of
an artery that could account for TIA) who did not receive
IVT, DAPT with ticagrelor (including loading dose) plus
aspirin for 30 days may be considered to reduce the risk of
30-day recurrent stroke.
2a B-R
14. (New and of High Impact) In patients with minor (NIHSS
score ≤5) noncardioembolic AIS or high-risk TIA (ABCD2
score ≥4) within 24 to 72 hours from stroke onset, or NIHSS
score of 4 to 5 within 24 hours from onset, who did not receive
IVT, with presumed atherosclerotic cause (≥50% stenosis
of intracranial or extracranial stenosis that was likely to have
accounted for clinical presentation or acute new infarctions
on imaging of presumed large artery atherosclerosis origin),
DAPT (clopidogrel and aspirin) for 21 days followed by SAPT
is reasonable to reduce the 90-day risk of recurrent stroke.
2b B-R
15. In patients with minor (NIHSS score ≤3) noncardioembolic
AIS or high-risk TIA (ABCD2 score ≥4) within 24 hours
after symptom onset who did not receive IVT and who carry
the CYP2C19 loss-of-function allele, DAPT with ticagrelor
and aspirin for 21 days (followed by ticagrelor monotherapy)
may be reasonable in preference over DAPT with clopidogrel
and aspirin to reduce the 90-day risk of recurrent stroke.
(cont'd)
