22109Insights into Using Dual Antiplatelet Therapy in Patients with Acute Ischemic Stroke and Transi

In this program, experts in the management of stroke with antiplatelet therapy will interpret clinical trial evidence and identify patients for use of DAPT.

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, residualrisk remains despite ASA monotherapy. The CHANCE and POINT trials, albeit with distinct differences, have demonstrated the effectiveness of the timely and shortterm addition of clopidogrel to ASA. However, patients with CYP2C19 loss-of-function (LOF) alleles are poor metabolizers of clopidogrel and often have a suboptimal response to dual antiplatelet therapy (DAPT) when clopidogrel is added to ASA. In the THALES trial, more potent antiplatelet therapy with the P2Y12 inhibitor ticagrelor, in combination with ASA, has demonstrated a reduction in risk of recurrent stroke in patients with mildto-moderate acute ischemic stroke or high-risk TIA. More recent insights from the THALES trial have assessed the effectiveness and safety of dual therapy with ticagrelor in reducing disabling stroke and disability after recurrent stroke, as well as outcomes in patients with and without ipsilateral atherosclerosis stenosis. Platelet reactivity has been compared between clopidogrel plus ASA and ticagrelor plus ASA in patients with TIA or minor stroke, and an ongoing trial is investigating clinical outcomes of TIA or minor stroke patients who are CYP2C19 LOF allele carriers and who are receiving either DAPT with ASA plus clopidogrel or ASA plus ticagrelor. In this program, experts in the management of stroke with antiplatelet therapy will interpret clinical trial evidence and identify patients for use of DAPT. A multi-specialty panel discussion (with representatives from neurology, emergency medicine, and internal medicine) will follow, with a focus on overcoming barriers to timely and successful implementation of DAPT.

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