What is the evidence for the use of DAPT in the short-term (21-90 days) for the prevention of recurrent ischemic stroke?
Evidence for the use of DAPT in the short-term for the prevention of recurrent ischemic stroke is informed by two major RCTs, (CHANCE and POINT trials) which both compared DAPT with SAPT with aspirin initiated early after onset (<24 and <12 hours, respectively) of minor stroke (NIHSS score 3) or high-risk TIA (ABCD2 score 4). Both trials demonstrated a reduction in recurrent ischemic stroke at 90 days. Further analyses of POINT revealed that the benefit of DAPT was seen primarily in the first 21 days. Meta-analyses that included other DAPT trials also have shown a reduction in recurrent stroke from DAPT compared with aspirin monotherapy, but the benefit is limited if not started early (<7 days) after the index event.