Would you recommend dual antiplatelet therapy or anticoagulation for a patient previously on aspirin who has a breakthrough stroke with history of CADASIL?

CADASIL is a genetic condition with a presumed mechanism of vascular injury to be disruption of the blood-brain barrier and non-atherosclerotic angiopathy. Thus, it makes sense that no anti-thrombotic has been show to reduce stroke risk. It's expert consensus to do daily aspirin, but this is more to...

Dual antiplatelet medications should be sufficient.