44
General Supportive Early Management
4.8. Antiplatelet Treatment
COR LOE
Recommendations
Antiplatelet erapy in the Setting of IVT
3: Harm B-R
16. In patients with AIS who are otherwise eligible for IVT or
mechanical thrombectomy, aspirin is not recommended as a
substitute for acute stroke treatment to improve patient outcomes.
3: Harm B-R
17. In patients with AIS who are eligible for IVT, IV aspirin
should not be administered concurrently or within 90
minutes after the start of IVT given the risk of hemorrhage.
3: No
benefit
B-R
18. In patients with AIS treated with IVT within 3 hours after
symptom onset, adjunctive treatment with IV eptifibatide is
not recommended to reduce disability at 3 months.
(cont'd)
Table 7. DAPT Trials
AIS DAPT
trial Inclusion Drug/duration LKN NNT
CHANCE AIS (NIHSS
≤3) or TIA
(ABCD ≥4)
Clopidogrel (300 mg load then
75 mg/d) + Asa (75 mg ) × 21 d
followed by clopidogrel
24 h 28
POINT* AIS (NIHSS
≤3) or TIA
(ABCD ≥4)
Clopidogrel (600 mg load then
75 mg/d) + Asa (50–325 mg/d)
× 90 d
12 h 67
THALES* AIS (NIHSS
≤5) or TIA
(ABCD ≥6)
Ticagrelor (180 mg load then 90
mg twice daily) + Asa (300–325 mg
load then 75–100 mg/d) × 30 d
24 h 91
CHANCE 2* AIS (NIHSS
≤3) or TIA
(ABCD ≥4)
and CYP2C19
loss-of-function
allele
Ticagrelor (180 mg load then 90 mg
twice daily) + Asa (75–300 mg load
then 75mg/d) × 21 d followed by
ticagrelor
24 h 63
INSPIRES AIS (NIHSS
≤5) or TIA
(ABCD ≥4),
presumed athero
Clopidogrel (300 mg load then 75
mg/d) + Asa (100–300 mg load
then 100mg/d) × 21 d followed by
clopidogrel
72 h 53
*Slight increased risk of bleeding.
ABCD indicates Age, Blood Pressure, Clinical Features, Duration (TIA risk score); AIS, acute
ischemic stroke; Asa, aspirin; athero, atherosclerosis; CHANCE, Clopidogrel in High-risk
patients with Acute Nondisabling Cerebrovascular Events; CHANCE 2, Clopidogrel versus
Ticagrelor in High-risk Patients with Acute Nondisabling Cerebrovascular Events; DAPT,
Dual Antiplatelet erapy; INSPIRES, Innovative Stroke Prevention and Intervention
Research Study; LKN, last known normal; NIHSS, National Institutes of Health Stroke
Scale; NNT, number needed to treat; POINT, Platelet-Oriented Inhibition in New TIA and
Minor Ischemic Stroke; THALES, Acute Stroke or Transient Ischemic Attack Treated with
Ticagrelor and ASA for Prevention of Stroke and Death; and TIA, transient ischemic attack.
