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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?

In light of the INSPIRES trial publication.
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What is the maximum time after symptom onset that you would start a patient on DAPT for the treatment of high risk TIA or minor stroke syndrome?

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4 Answers
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Neurology · Vanderbilt University Medical Center
Answered on

Immediately. Unless tPA has been given, then at 24 hours.

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Neurology · Kaiser Permanente
Answered on

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.

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Neurology · University of Colorado, Climate & Health Dept
Answered on

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

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Neurology · Mather Hospital
Answered on

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

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