Objectives Short-term dual antiplatelet therapy (DAPT) with clopidogrel and aspirin for secondary prevention in transient ischemic attack (TIA) has been shown to reduce 90-day stroke risk, including for symptomatic high-grade carotid stenosis >50%.1–3 Beyond 30 days, haemorrhagic complications outweighed benefits.3 At our institution, there remains hesitancy of the use of DAPT. We aim to determine prescription rate of DAPT by Emergency Department (ED) versus Stroke Unit (SU) and evaluate 90-day stroke and bleeding risk.
Methods Retrospective analysis was performed on all TIA patients admitted to Barwon Health between January 2019 to July 2020. Patients commenced on 21-day DAPT were identified. High-risk TIA was defined as symptomatic carotid stenosis >50%. Bleeding risk was defined as major haemorrhage i.e. symptomatic intracranial haemorrhage or gastrointestinal bleeding.
Results 208 TIA patients were identified; 127 patients and 81 patients were admitted to ED and SU respectively. A higher rate of DAPT prescription was seen in the SU at 33.3% (27/81) versus 16.5% (21/127) in ED. 18.5% (5/27) SU patients versus 14.3% (3/21) ED patients were deemed to have had high-risk TIA. No cases of recurrent stroke or major haemorrhage at 90 days were seen in patients receiving DAPT.
Conclusion DAPT prescription is lower in ED when compared to SU. At Barwon Health, consultation with the stroke team is encouraged to facilitate high-risk TIA management. A low 90-day stroke and bleeding risk on short term DAPT for TIA was observed in this study. Given our small sample size, this finding may not be generalisable to different settings.
Hackam DG, Spence JD. Antiplatelet therapy in ischemic stroke and transient ischemic attack. Stroke 2019 Mar;50(3):773–778.
Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, et al; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11–19.
Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 2018;379:215–225.
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