For minor ischaemic stroke or high-risk transient ischaemic attack, short-course dual antiplatelet therapy with aspirin and clopidogrel, started early, reduces recurrent stroke compared with aspirin alone. The benefit is concentrated in the first days, which is why timing matters.
Major guidelines advise starting within 24 hours where possible and stopping the second agent after about 21 days, because longer use raises bleeding without adding much protection. A loading dose of clopidogrel is usually given.
- Start aspirin plus clopidogrel early, ideally within 24 hours, after minor stroke or high-risk TIA
- Give a clopidogrel loading dose
- Stop the second agent after about 21 days and continue single antiplatelet therapy
- Exclude haemorrhage on imaging before starting
Why it matters
Most of the benefit is lost if dual therapy starts late or the bleeding risk is carried for months.
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