Double antiplatelet

Posted On January 30, 2023

Double antiplatelet therapy (DAPT) indications

High risk TIA that is ABCD2 score > or = 4: DAPT for 21 days
Minor ischemic stroke, that is NIHSS < or =5: DAPT for 21 days
Intracranial large artery stenosis 70 to 99%. DAPT for 90 days
Before and after carotid stent: start DAPT before stent, after stent, treat for 30 days

Loading dose
Aspirin 325 mg + Clopidogrel 300 mg (75 MG X 4)
Maintenance dose
Aspirin 81 mg qd, and Clopidogrel 75 mg qd

For patients with no TIA OR stroke
DAPT not indicated for stroke prevention

Transient Ischemic Attack from extracranial ICA stenosis

consider endarterectomy (CEA) or Stent (CAS)
– For CEA: Aspirin before and after CEA
– For CAS: DAPT before CAS, and for 30 days after CAS

Transient Ischemic Attack from intracranial ICA stenosis

Stenosis 70 to 99% stenosis: DAPT for 90 days, then single antiplatelet
Stenosis 50-69% stenosis:
— ABCD2 score <4, low risk TIA: single antiplatelet
— ABCD2 score > or = 4: DAPT for 21 days, then single antiplatelet

ABCD2 score

Age	> 60 years old: +2
BP at Transient Ischemic Attack	SBP >140 or DBP > 90: +1
Clinical	unilateral weakness: +2 Isolated speech disturbance: +1
Duration of Transient Ischemic Attack	>60 min: +2 10-59 minutes: +1
Diabetes	present: +1