22101Keys to Prevention and Risk Reduction with Antiplatelet Therapy in Patients with Acute Ischemic Stroke and Transient Ischemic Attack

In this program, Chair Dr. S. Claiborne Johnston, Dr. Brett Cucchiara, Dr. Louise McCullough, and Dr. Carlos Molina will interpret the evidence for DAPT, provide insights into the choice of clopidogrel or ticagrelor to add to ASA, describe deficiencies in care preventing optimal use of DAPT, and explain remedies.

There is a substantial risk for recurrent stroke in the early period after an acute ischemic stroke or transient ischemic attack (TIA). Aspirin (ASA) has been a fundamental preventive therapy in these patients; however, residual risk remains despite ASA monotherapy. The CHANCE and POINT trials, albeit with distinct differences, have demonstrated the effectiveness of the timely and short-term addition of clopidogrel to ASA. Recently, in the THALES trial, more potent antiplatelet therapy with the P2Y12 inhibitor ticagrelor, in combination with ASA, has demonstrated a reduction in the risk of recurrent stroke in patients with mild-to-moderate acute ischemic stroke or high-risk TIA. Unfortunately, dual antiplatelet therapy (DAPT) is underutilized in these patients. In this program, Chair Dr. S. Claiborne Johnston, Dr. Brett Cucchiara, Dr. Louise McCullough, and Dr. Carlos Molina will interpret the evidence for DAPT, provide insights into the choice of clopidogrel or ticagrelor to add to ASA, describe deficiencies in care preventing optimal use of DAPT, and explain remedies.

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