What is the evidence for the benefit of short-term DAPT in preventing recurrent ischemic stroke?
The benefit of DAPT in reducing recurrent ischemic stroke has been demonstrated in two major RCTs, the CHANCE and POINT trials, and a systematic review by an AHA Evidence Review Committee. The CHANCE and POINT trials both showed a reduction in recurrent ischemic stroke at 90 days when DAPT was used instead of SAPT with aspirin, although the duration of DAPT treatment and dosing of both aspirin and clopidogrel were slightly different between the two trials. Further analyses of the POINT trial revealed that the benefit of DAPT was seen primarily in the first 21 days. Meta-analyses that included other DAPT trials have also shown a reduction in recurrent stroke from DAPT compared with aspirin monotherapy, although the benefit is limited if not started early (<7 days) after the index event.