Effects of Dual Antiplatelet Therapy on Secondary Stroke Prevention

Abstract: Dual antiplatelet therapy (DAPT), predominantly combining aspirin and clopidogrel, has become a cornerstone in the strategy for secondary stroke prevention, particularly in the immediate aftermath of an initial stroke or transient ischemic attack (TIA). This paper provides a comprehensive analysis of DAPT's efficacy, safety profile, and overall clinical implications compared to single antiplatelet therapy (SAPT),which typically involves the use of aspirin. The study focuses on the therapeutic balance DAPT offers—significant benefits in reducing early stroke recurrence weighed against the notable increased risk of major bleeding events. Through an extensive review and synthesis of key clinical trials, including the CHANCE (Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events), POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke), and MATCH (Management of Atherothrombosis with Clopidogrel in High-risk patients) trials, this research elucidates the circumstances under which DAPT provides the most substantial benefits. The CHANCE and POINT trials, for instance, demonstrated a 25-30% reduction in recurrent stroke risk within the first 90 days post-stroke when using DAPT, underscoring its efficacy in the critical early phase of stroke management. However, these benefits are tempered by findings from the MATCH trial and others, which highlight a significantly elevated risk of major bleeding, particularly in certain patient demographics such as older adults or those with multiple comorbidities. This paper synthesizes current knowledge on the clinical advantages and limitations of DAPT but also explores the nuanced patient selection criteria that could optimize its use. By analyzing the results of these pivotal trials, the study offers valuable insights into refining secondary stroke prevention strategies, aiming to improve patient outcomes through more individualized and balanced therapeutic approaches. The findings presented here will contribute to the ongoing evolution of clinical guidelines, ensuring that DAPT is used effectively and safely to prevent recurrent strokes.

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Article Contents 

18 min

Introduction Literature Review Methods Results Discussion Conclusions & Future Directions References

Introduction  

Strokes occur when blood flow to a part of the brain is blocked or disrupted. There are two primary causes: ischemic, where blood flow is blocked by a clot, and hemorrhagic, where blood flow is disrupted due to a brain bleed. A common method of stroke prevention is the use of platelet anti-aggregation medications like aspirin, which help prevent ischemic strokes. Platelets are clotting factors in the blood, designed to stop blood loss whenever there is a wound, whether inside the body or external. In both cases, platelets gather at the site of the injury to form a clot that plugs the hole. However, platelets can sometimes form clots where they are not needed, blocking blood flow to vital areas of the body. 

Aspirin works by preventing platelets from aggregating, reducing the risk of clot formation. Unfortunately, in some cases, aspirin alone is insufficient. To improve outcomes in ischemic stroke prevention, dual antiplatelet therapy (DAPT) has been introduced. DAPT typically involves the combination of aspirin and clopidogrel, targeting different platelet aggregation pathways to enhance clot prevention. While DAPT has proven effective in reducing recurrent strokes, it is also associated with a higher risk of major bleeding events. 

This research paper explores the impact of DAPT on secondary stroke prevention, focusing on the balance between its benefits and risks. By examining existing literature and clinical trials, this study aims to provide a comprehensive understanding of the optimal use of DAPT in preventing recurrent strokes. It evaluates the efficacy and safety profiles of DAPT compared to single antiplatelet therapy (SAPT), aiming to inform