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The Efficacy of Early Antiplatelet Therapy in Reducing Stroke Recurrence

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Ayanna Amadi
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The Efficacy of Early Antiplatelet Therapy in Reducing Stroke Recurrence

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Ischemic stroke, a condition characterized by the obstruction of blood flow to the brain, poses a significant health risk worldwide. Early treatment is crucial to mitigate the potential for recurrent strokes. One approach to treatment, the administration of antiplatelet therapy using clopidogrel and aspirin, has been found to be effective if administered within 24 hours of symptom onset. However, the efficacy and safety of this dual antiplatelet therapy (DAPT) when used within 72 hours have not been well studied until now.

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Early DAPT Reduces New Stroke Risk

Recent research published in the New England Journal of Medicine suggests that DAPT, comprising clopidogrel and aspirin administered within 72 hours of a mild ischemic stroke or high-risk transient ischemic attack, demonstrates a greater risk reduction for new stroke than the use of aspirin alone. Although these findings are promising, it's important to note that the study also found a higher risk of bleeding associated with DAPT.

The study, which was supported by grants from the National Natural Science Foundation of China, the National Key R&D Program of China, and other sources, involved a randomized two-by-two factorial trial with 3,050 patients in each group. Results showed that 7.3 percent of patients in the clopidogrel-aspirin group had a new stroke at 90 days, compared to 9.2 percent in the aspirin group alone.

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Increased Risk of Bleeding with DAPT

While the study shows a reduction in new stroke risk, it also found that moderate-to-severe bleeding occurred in 0.9 percent of patients in the clopidogrel-aspirin group and 0.4 percent in the aspirin group. This highlights the need for healthcare providers to balance the potential benefits of early DAPT with the associated bleeding risk.

Expanding the Time Window for DAPT

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Despite the increased bleeding risk, this research provides evidence to support expanding the time window for DAPT to 72 hours. The INSPIRES trial showed that DAPT can be beneficial for minor ischemic stroke when administered within this timeframe, reducing the risk of new stroke within 90 days.

These findings led the American Heart Association to update its guidelines to recommend a 21-day course of aspirin plus clopidogrel within 24 hours for patients with noncardioembolic ischemic stroke and low NIHSS scores. However, the trial emphasized that DAPT appears to be underutilized in clinical practice.

In summary, this research provides valuable insights into the potential benefits of early antiplatelet therapy in reducing the risk of stroke recurrence. As with any treatment, the potential benefits must be balanced against potential risks, in this case, the increased risk of bleeding. As always, patients should discuss treatment options with their healthcare provider to make an informed decision.

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