Effectiveness of Dual Antiplatelet Therapy (DAPT) to Reduce Stroke Recurrence in Patients with Minor Stroke or High Risk Transient Ischemic Attach (TIA): A Comprehensive Systematic Review
Keywords:
dual antiplatelet therapy, transient ischemic attack, ischemic strokeAbstract
Background Patients who experience a minor stroke or a high-risk transient ischemic attack (TIA) are at an increased risk of stroke recurrence. Effective secondary prevention strategies are critical to reducing the burden of stroke-related morbidity and mortality. This systematic review aims to evaluate the effectiveness of DAPT in reducing stroke recurrence in patients with minor stroke or high-risk TIA. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2015 to 2025. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 1.800 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: DAPT is a superior strategy compared to SAPT in reducing stroke recurrence in patients with minor stroke or high-risk TIA. However, its safety concerns, particularly regarding major bleeding, necessitate careful patient selection and treatment duration optimization. Current data suggest that a 21-day DAPT regimen followed by SAPT offers the best balance of efficacy and safety, particularly in patients with atherosclerotic stroke. Future studies should continue refining treatment approaches to maximize the benefits of DAPT while minimizing risks.
References
Chan BP, Wong LY, Tan BY, Yeo LL, Venketasubramanian N. Dual antiplatelet therapy for the acute management and long-term secondary prevention of ischemic stroke and transient ischemic attack, an updated review. J Cardiovasc Dev Dis. 2024;11(2):48.
Dawson J, Merwick Á, Webb A, et al. European Stroke Organisation expedited recommendation for the use of short-term dual antiplatelet therapy early after minor stroke and high-risk TIA. Eur Stroke J. 2021;6(2):CLXXXVII-CXCI. doi:10.1177/23969873211000877
Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet Lond Engl. 2004;364(9431):331-337. doi:10.1016/S0140-6736(04)16721-4
Dong J, Wang F, Sundararajan S. Use of Dual Antiplatelet Therapy Following Ischemic Stroke. Stroke. 2020;51(5). doi:10.1161/STROKEAHA.119.028400
Lee HL, Kim JT, Lee JS, et al. Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Mild-to-Moderate Acute Ischemic Stroke According to the Risk of Recurrent Stroke: An Analysis of 15 000 Patients From a Nationwide, Multicenter Registry. Circ Cardiovasc Qual Outcomes. 2020;13(11):e006474. doi:10.1161/CIRCOUTCOMES.119.006474
Condello F, Liccardo G, Ferrante G. Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis. Curr Pharm Des. 2021;27(40):4140-4146. doi:10.2174/1381612827666210728102459
Tillman H, Johnston SC, Farrant M, et al. Risk for Major Hemorrhages in Patients Receiving Clopidogrel and Aspirin Compared With Aspirin Alone After Transient Ischemic Attack or Minor Ischemic Stroke: A Secondary Analysis of the POINT Randomized Clinical Trial. JAMA Neurol. 2019;76(7):774. doi:10.1001/jamaneurol.2019.0932
Wang Y, Pan Y, Zhao X, et al. Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year Outcomes. Circulation. 2015;132(1):40-46. doi:10.1161/CIRCULATIONAHA.114.014791
Johnston SC, Elm JJ, Easton JD, et al. Time Course for Benefit and Risk of Clopidogrel and Aspirin After Acute Transient Ischemic Attack and Minor Ischemic Stroke: A Secondary Analysis from the POINT Randomized Trial. Circulation. 2019;140(8):658-664. doi:10.1161/CIRCULATIONAHA.119.040713
Suryawanshi VR, Patwal S, Doshi V, Iyer S, Raut A. Efficacy and safety of dual-antiplatelet therapy with high-intensity statin versus single-antiplatelet therapy with high-intensity statin in patients with stroke or high-risk mini-stroke of atherosclerotic origin: A cohort study. J Neurosci Rural Pract. 2025;16(1):44.
Bhatia K, Jain V, Aggarwal D, et al. Dual Antiplatelet Therapy Versus Aspirin in Patients With Stroke or Transient Ischemic Attack: Meta-Analysis of Randomized Controlled Trials. Stroke. 2021;52(6). doi:10.1161/STROKEAHA.120.033033
He F, Xia C, Zhang JH, et al. Clopidogrel plus aspirin versus aspirin alone for preventing early neurological deterioration in patients with acute ischemic stroke. J Clin Neurosci. 2015;22(1):83-86. doi:10.1016/j.jocn.2014.05.038
Li Z, Wang Y, Zhao X, et al. Treatment Effect of Clopidogrel Plus Aspirin Within 12 Hours of Acute Minor Stroke or Transient Ischemic Attack. J Am Heart Assoc. 2016;5(3):e003038. doi:10.1161/JAHA.115.003038
Trifan G, Gorelick PB, Testai FD. Efficacy and Safety of Using Dual Versus Monotherapy Antiplatelet Agents in Secondary Stroke Prevention: Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials. Circulation. 2021;143(25):2441-2453. doi:10.1161/CIRCULATIONAHA.121.053782
Brown DL, Levine DA, Albright K, et al. Benefits and Risks of Dual Versus Single Antiplatelet Therapy for Secondary Stroke Prevention: A Systematic Review for the 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. Stroke. 2021;52(7). doi:10.1161/STR.0000000000000377
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Copyright (c) 2025 Jeremy Jovanie Owen Tobing, Eka Pranata (Author)
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