Such patients should have imaging as soon as possible.We are most confident of the stroke reduction with clopidogrel in the first seven days after commencement. Aims of the Review. The panel then met online to discuss the evidence and to formulate recommendations. The panel believed that most patients would consider a stroke considerably worse than a bleed and so would choose DAPT over single agent therapy. The aim of this single-center prospective study was to reduce the low response incidence of dual antiplatelet therapy … Dove Medical Press Disclaimer: This infographic is not a validated clinical decision aid. National clinical guideline for stroke 2016. 2008 Feb;30(2):249-59. doi: 10.1016/j.clinthera.2008.02.006.J Neurol Sci. So it is plausible that the two drugs together may provide better secondary prevention of stroke than one. Review of all available randomised trials that assessed dual antiplatelet therapy (clopidogrel and aspirin) versus aspirin monotherapy after a high risk transient ischaemic attack or minor stroke Expanded version of the results with multilayered recommendations, evidence summaries, and decision aids for use on all devicesSingle antiplatelet therapy with aspirin or clopidogrel is an effective intervention for both short and long term secondary prevention of stroke and transient ischaemic attack after an index event. Aspirin and clopidogrel decrease this risk, even more so when used in combination. In our judgment no panel member had relevant financial conflicts of interest; intellectual and professional conflicts were minimised and transparently described (see appendix 1 on bmj.com).Characteristics of patients and trials included in systematic review of the use of DAPT (clopidogrel plus aspirin) versus aspirin monotherapy given within 12-24 hours of symptom onset in patients with high risk transient ischaemic attack (TIA) or minor strokeDAPT decreased all (ischaemic and haemorrhagic) non-fatal recurrent stroke (risk ratio 0.70 (95% confidence interval 0.61 to 0.80), high certainty)DAPT led to small improvements in functional disability (moderate certainty) and quality of life (moderate certainty)DAPT led to a small, possibly important increase in moderate or major extracranial bleeding (moderate certainty) (see main infographic).The RCTs varied from 396 participants to 5170; the two largest trials contributed 10 051 patients. However, the following considerations may be useful:Clopidogrel and aspirin doses used in intervention arms of the trials included in the systematic reviewThe addition of a second agent, likely clopidogrel, adds to the immediate cost of treatment. Clipboard, Search History, and several other advanced features are temporarily unavailable. For the full disclaimer wording see BMJ's terms and conditions: People with high risk transient ischaemic attack or minor ischaemic stroke are at an increased risk of recurrent stroke and deathAspirin and clopidogrel decrease this risk, even more so when used in combinationWe make a strong recommendation for dual antiplatelet therapy (DAPT) with clopidogrel and aspirin to be started within 24 hours in patients who have had a high risk transient ischaemic attack or minor strokeWe make a strong recommendation for DAPT to be continued for 10-21 days, at which point patients should continue with single antiplatelet therapyDAPT is not to be used for major stroke because of the increased risk of intracranial bleeding in these patientsThe recommendations in this clinical practice guideline are based on a linked systematic reviewThis Rapid Recommendation aims to quickly and transparently translate evidence for working clinicians and their patients in adherence with standards for trustworthy guidelines and the GRADE system.Prasad K, Siemieniuk R, Hao Q, et al. One trial was conducted in China,The infographic provides an overview of the recommendation, the benefits and harms, and our certainty in the evidence. If adverse effects are minor, patients may be well advised to continue until at least seven days.There were no head to head comparisons in the studies to give clear guidance on what loading and maintenance dose to offer. 2013 Jun 14;12:87. doi: 10.1186/1475-2840-12-87.Hsiao FY, Tsai YW, Huang WF, Wen YW, Chen PF, Chang PY, Kuo KN.Clin Ther. Dual antiplatelet therapy using acetylsalicylic acid (ASA, aspirin) and clopidogrel is of great importance following coronary stenting.