When do you consider starting short-term DAPT in patients who present more than 24 hours after the onset of a high-risk TIA or minor stroke syndrome?

The literature states that DAPT is most effective when started within the first 24 hours after such an event, but is still effective as far as 72 hours later. So if the patient presents more than 24 hours later, but not later than 72 hours, I would still start it then but would want a CT scan first.

Typically up to a week from symptom onset, not based on data.

Immediately if no absolute contraindications. If treated with TNK, in 24 hours after confirmation of no hemoconversion.

Data per the INSPIRES trial (NEJM 2023) that expanded the prior DAPT window established in POINT/CHANCE, treat immediately and up to 72 hours after symptom onset with DAPT.

All of the evidence favoring DAPT following high-risk TIA or minor stroke charts benefit in the first 48-72 hours. Later DAPT is no better than aspirin monotherapy.

If the recommendations are for DAPT for 21 days after a CVA/TIA, why wouldn't you consider starting it at any time up to 21 days if the patient delayed initiation for whatever reason (except for bleed)?