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EBM Verdict
Emergency care
Single or dual antiplatelet therapy after a transient ischaemic attack or minor ischaemic stroke?
  1. Kamal R Mahtani,
  2. Carl Heneghan,
  3. Jeffrey Aronson
  1. Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Kamal R Mahtani, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; kamal.mahtani{at}phc.ox.ac.uk

https://doi.org/10.1136/bmjebm-2019-111160

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    A recent systematic review provides evidence on the antiplatelet treatment needed after these types of stroke.

    Why is this important?

    An average 55-year-old man has a 1 in 6 risk of stroke during his lifetime; a woman’s risk is 1 in 5.1 A significant proportion will suffer long-term functional, cognitive and psychological disabilities. Stroke also has a significant impact on health service providers. One economic evaluation has estimated that an average patient may need £50 000 worth of health and social care in the 5 years after an acute stroke.2

    In a transient ischaemic attack (TIA) symptoms resolve within 24 hours. However, a TIA puts patients at high risk (up to 8% within 7 days) of a subsequent stroke.3 Clinical prediction tools, such as the ABCD2 score, can help risk stratify those most likely to go on and have a stroke.4 5

    What is current practice?

    Patients with suspected TIA are treated as a medical emergency with management including giving aspirin immediately and urgent assessment.3

    However, there is uncertainty in some clinical guidelines about the use of single or dual antiplatelet agents following an ischaemic stroke or TIA. Current National Institute for Health and Care Excellence(NICE) guidance advocates monotherapy (usually clopidogrel) following a non-disabling stroke or TIA. Dual therapy may be considered for 90 days, …

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    Footnotes

    • Contributors KRM and CH oversaw the first draft and JA provided additional comments.

    • Funding All authors are supported by the BMJ Evidence Based Medicine journal in their roles as editors. KRM and CH are also supported by the National Institute for Health Research School for Primary Care Research Evidence Synthesis Working Group (project number 390).

    • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the host institutions, NIHR or the Department of Health and Social Care.

    • Competing interests KRM and CH report grants from the NIHR including the NIHR School of Primary Care Research Evidence Synthesis Working Group (project number 390). KRM and JA are associate editors of the BMJ EBM journal. CH is Editor in Chief of the BMJ EBM journal.

    • Provenance and peer review Commissioned; internally peer reviewed.

    • Patient consent for publication Not required.