Role of antiplatelet agents following ischemic stroke:
Antiplatelet agents are used primarily for secondary prevention of recurrent ischemic stroke and transient ischemic attack (TIA). Aspirin 300 mg daily should be started as soon as possible, ideally within 24 hours of stroke onset, once intracerebral hemorrhage has been excluded by brain imaging. This initial aspirin dose is continued for 2 weeks, after which long-term antiplatelet therapy is commenced. If aspirin is contraindicated or not tolerated, alternatives such as clopidogrel or modified-release dipyridamole may be used.
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel or aspirin plus ticagrelor may be initiated in secondary care for selected patients with non-cardioembolic minor ischemic stroke or high-risk TIA, typically for a short duration (21 to 30 days), followed by antiplatelet monotherapy. This approach reduces the risk of stroke recurrence but carries a slightly increased risk of intracranial hemorrhage.
Antiplatelet therapy is not a substitute for anticoagulation in patients with cardioembolic stroke (e.g., due to atrial fibrillation), where anticoagulants are indicated instead.