What role do antiplatelet agents play in the management of patients po

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Role of antiplatelet agents following ischemic stroke:

Antiplatelet agents are used primarily for secondary prevention of recurrent ischemic stroke and other vascular events in patients who have had an ischemic stroke.
Initial treatment in acute ischemic stroke includes aspirin 300 mg daily started as soon as possible (within 24 hours) after excluding intracerebral hemorrhage by brain imaging, continued for 2 weeks, then switching to long-term antiplatelet therapy .
Clopidogrel is recommended as the most cost-effective antiplatelet agent for long-term secondary prevention after ischemic stroke ,.
Modified-release dipyridamole 200 mg twice daily may be used if clopidogrel and aspirin are contraindicated or not tolerated; aspirin 75 mg daily is an alternative if both clopidogrel and dipyridamole are unsuitable .
Dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel may be initiated for up to 21–90 days in secondary care for patients with minor non-cardioembolic ischemic stroke or high-risk transient ischemic attack (TIA), followed by monotherapy ,.
DAPT with aspirin plus ticagrelor for 30 days may be considered in some cases of mild to moderate non-cardioembolic ischemic stroke or high-risk TIA .
Long-term antiplatelet therapy is generally started after the initial 2-week aspirin period, or earlier if the patient is discharged before 2 weeks .
Antiplatelet treatment is not routinely recommended for primary prevention but is essential for secondary prevention after ischemic stroke .

What role do antiplatelet agents play in the management of patients post-ischaemic stroke?