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

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 ³.
• Clopidogrel is recommended as the most cost-effective antiplatelet agent for long-term secondary prevention after ischemic stroke ¹,².
• 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 ².
• 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 ²,³.
• 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 ².
• Long-term antiplatelet therapy is generally started after the initial 2-week aspirin period, or earlier if the patient is discharged before 2 weeks ³.
• Antiplatelet treatment is not routinely recommended for primary prevention but is essential for secondary prevention after ischemic stroke ¹.