Skip to main content

Advertisement

SpringerLink
Log in

Dual Antiplatelet Therapy in Ischemic Stroke Prevention: Which Two Could Be Better than One?

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Recurrent stroke after ischemic stroke (IS) or high-risk transient ischemic attack (TIA) increases morbidity and mortality. Secondary stroke prevention strategies include modification of behavioral and vascular risk factors and antithrombotic use, including single or dual antiplatelet therapy (DAPT). In this review, we focus on DAPT indications, combinations, and treatment duration.

Recent findings

Studies showed that for patients with mild to moderate non-cardioembolic strokes or those with symptomatic intracranial or mild extracranial stenosis (≤ 30% diameter reduction), short-term DAPT (21–90 days) with aspirin plus clopidogrel, compared with mono-antiplatelet therapy (MAPT), decreases recurrent stroke risk without significantly increasing major bleeding risk. The combination of aspirin plus extended release dipyridamole or cilostazol may confer decrease of risk for recurrent stroke with long-term use, at the expense of increasing major bleeding risk. Treatment with aspirin plus ticagrelor for a short time period is superior to aspirin monotherapy for decreasing risk for recurrent stroke, but significantly increases the risk for major bleeding.

Summary

Short-term DAPT with aspirin plus clopidogrel, compared with MAPT, decreases risk for recurrent stroke without increasing major bleeding risk. Short-term DAPT with aspirin plus ticagrelor also reduces risk for recurrent stroke, but with a significant increase in the risk of major bleeding, compared with MAPT. Direct comparisons among different DAPT regimens are currently underway.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as:

    • Of importance

      •• Of major importance

      1. • Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 Update. Circulation. 2021;143(8):e254–743. https://doi.org/10.1161/CIR.0000000000000950. Manuscript reviews latest statistics on stroke/TIA incidence, prevalence,vascular risk factors and baseline charctheristics of stroke/TIA patients.

        Article  PubMed  Google Scholar 

      2. Albright KC, Huang L, Blackburn J, Howard G, Mullen M, Bittner V, et al. Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality. Neurology. 2018;91(19):e1741–50. https://doi.org/10.1212/WNL.0000000000006467.

        Article  PubMed  PubMed Central  Google Scholar 

      3. Amarenco P, Lavallée PC, Labreuche J, Albers GW, Bornstein NM, Canhão P, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016;374(16):1533–42. https://doi.org/10.1056/NEJMoa1412981.

        Article  CAS  PubMed  Google Scholar 

      4. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913–24. https://doi.org/10.1016/S1474-4422(16)30073-4.

        Article  PubMed  Google Scholar 

      5. Boehme AK, Esenwa C, Elkind MS. Stroke risk factors, genetics, and prevention. Circ Res. 2017;120(3):472–95. https://doi.org/10.1161/CIRCRESAHA.116.308398.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      6. Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001;32(12):2735–40. https://doi.org/10.1161/hs1201.100209.

        Article  CAS  PubMed  Google Scholar 

      7. Gardener H, Sacco RL, Rundek T, Battistella V, Cheung YK, Elkind MSV. Race and ethnic disparities in stroke incidence in the Northern Manhattan Study. Stroke. 2020;51(4):1064–9. https://doi.org/10.1161/STROKEAHA.119.028806.

        Article  PubMed  PubMed Central  Google Scholar 

      8. •• Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364–467. https://doi.org/10.1161/STR.0000000000000375. Manuscript provided up-to-date guidelines on secondary stroke prevention and reviews the evidence associated with these guidelines.

        Article  PubMed  Google Scholar 

      9. Sposato LA, Cipriano LE, Saposnik G, Ruiz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14(4):377–87. https://doi.org/10.1016/S1474-4422(15)70027-X.

        Article  PubMed  Google Scholar 

      10. van der Maten G, Reimer JMB, Meijs MFL, von Birgelen C, Brusse-Keizer MGJ, den Hertog HM. Detection of major cardioembolic sources in real-world patients with ischemic stroke or transient ischemic attack of undetermined cause. Cerebrovasc Dis Extra. 2021;11(1):22–8. https://doi.org/10.1159/000512743.

        Article  PubMed  PubMed Central  Google Scholar 

      11. Messas E, Goudot G, Halliday A, Sitruk J, Mirault T, Khider L, et al. Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review. Eur Heart J Suppl. 2020;22(Suppl M):M35–42. https://doi.org/10.1093/eurheartj/suaa162.

        Article  PubMed  PubMed Central  Google Scholar 

      12. Levine SR. Hypercoagulable states and stroke: a selective review. CNS Spectr. 2005;10(7):567–78. https://doi.org/10.1017/s109285290001021x.

        Article  PubMed  Google Scholar 

      13. • Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418. https://doi.org/10.1161/STR.0000000000000211. Manuscript reviews latest guidelines on recommended stroke/TIA screening, work-up and management of stroke/TIA.

        Article  PubMed  Google Scholar 

      14. Wallentin L. P2Y12 inhibitors: differences in properties and mechanisms of action and potential consequences for clinical use. Eur Heart J. 2009;30(16):1964–77. https://doi.org/10.1093/eurheartj/ehp296.

        Article  CAS  PubMed  Google Scholar 

      15. Goto S. Cilostazol: potential mechanism of action for antithrombotic effects accompanied by a low rate of bleeding. Atheroscler Suppl. 2005;6(4):3–11. https://doi.org/10.1016/j.atherosclerosissup.2005.09.002.

        Article  CAS  PubMed  Google Scholar 

      16. Vane JR, Botting RM. The mechanism of action of aspirin. Thromb Res. 2003;110(5–6):255–8. https://doi.org/10.1016/s0049-3848(03)00379-7.

        Article  CAS  PubMed  Google Scholar 

      17. Kambayashi J, Liu Y, Sun B, Shakur Y, Yoshitake M, Czerwiec F. Cilostazol as a unique antithrombotic agent. Curr Pharm Des. 2003;9(28):2289–302. https://doi.org/10.2174/1381612033453910.

        Article  CAS  PubMed  Google Scholar 

      18. Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345(20):1444–51. https://doi.org/10.1056/NEJMoa011258.

        Article  CAS  PubMed  Google Scholar 

      19. De Schryver EL, Algra A, Kappelle LJ, van Gijn J, Koudstaal PJ. Vitamin K antagonists versus antiplatelet therapy after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin. Cochrane Database Syst Rev. 2012;2012(9):Cd001342. https://doi.org/10.1002/14651858.CD001342.pub3.

      20. •• Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018;379(3):215–25. https://doi.org/10.1056/NEJMoa1800410. Major randomized controlled clinical trial investigating efficacy and safety of DAPT regimen for minor non-cardioemnbolic stroke/TIA in US population.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      21. •• Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369(1):11–9. https://doi.org/10.1056/NEJMoa1215340. Major randomized controlled clinical trial investigating efficacy and safety of DAPT regimen for minor non-cardioemnbolic stroke/TIA in mainly Chinese population.

        Article  CAS  PubMed  Google Scholar 

      22. Sacco RL, Diener HC, Yusuf S, Cotton D, Ounpuu S, Lawton WA, et al. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med. 2008;359(12):1238–51. https://doi.org/10.1056/NEJMoa0805002.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      23. Sivenius J, Cunha L, Diener HC, Forbes C, Laakso M, Lowenthal A, et al. Second European Stroke Prevention Study: antiplatelet therapy is effective regardless of age. ESPS2 Working Group. Acta Neurol Scand. 1999;99(1):54–60. https://doi.org/10.1111/j.1600-0404.1999.tb00658.x.

      24. • A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). The Lancet. 1996;348(9038):1329–39. https://doi.org/10.1016/S0140-6736(96)09457-3. Early randomized, blinded, international trial comparing efficacy and safety of clopidogrel to aspirin for patients with atherosclertoic diease.

      25. • Trifan G, Gorelick PB, Testai FD. Efficacy and safety of using dual versus monotherapy antiplatelet agents in secondary stroke prevention: systematic review and meta-analysis of randomized controlled clinical trials. Circulation. 2021;143(25):2441–53. https://doi.org/10.1161/CIRCULATIONAHA.121.053782. Up-to-date meta-analysis reviewing effiacy and safety of DAPT by agent type and DAPT duration

        Article  PubMed  Google Scholar 

      26. Patti G, Sticchi A, Bisignani A, Pelliccia F, Pasceri V, Speciale G, et al. Meta-regression to identify patients deriving the greatest benefit from dual antiplatelet therapy after stroke or transient ischemic attack without thrombolytic or thrombectomy treatment. Am J Cardiol. 2019;124(4):627–35. https://doi.org/10.1016/j.amjcard.2019.05.013.

        Article  PubMed  Google Scholar 

      27. •• Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331–7. https://doi.org/10.1016/S0140-6736(04)16721-4. Seminal randomized double placebo trial investigating DAPT with aspirin and clopidogrel to clopidogrel on recurrent stroke/TIA events.

        Article  CAS  PubMed  Google Scholar 

      28. •• Pan Y, Elm JJ, Li H, Easton JD, Wang Y, Farrant M, et al. Outcomes associated with clopidogrel-aspirin use in minor stroke or transient ischemic attack: a pooled analysis of clopidogrel in high-risk patients with acute non-disabling cerebrovascular events (CHANCE) and platelet-oriented inhibition in new TIA and minor ischemic stroke (POINT) trials. JAMA Neurol. 2019;76(12):1466–73. https://doi.org/10.1001/jamaneurol.2019.2531. Pooled analysis of two of major randomized controlled trials that investigated efficacy and safety of short term DAPT on stroke recurrence and major bleeding.

        Article  PubMed  PubMed Central  Google Scholar 

      29. Johnston SC, Amarenco P, Denison H, Evans SR, Himmelmann A, James S, et al. Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med. 2020;383(3):207–17. https://doi.org/10.1056/NEJMoa1916870.

        Article  CAS  PubMed  Google Scholar 

      30. •• Wang Y, Johnston C, Bath PM, Meng X, Jing J, Xie X, et al. Clopidogrel with aspirin in high-risk patients with acute non-disabling cerebrovascular events II (CHANCE-2): rationale and design of a multicentre randomised trial. Stroke Vasc Neurol. 2021;6(2):280–5. https://doi.org/10.1136/svn-2020-000791. Ongoing trial that will be a direct head-to-head comparison between aspirin and clopidogrel and aspirin plus ticagrelor combinations on efficacy and safety of DAPT on recurrent stroke and major bleeding.

        Article  PubMed  PubMed Central  Google Scholar 

      31. Becker RC, Bassand JP, Budaj A, Wojdyla DM, James SK, Cornel JH, et al. Bleeding complications with the P2Y12 receptor antagonists clopidogrel and ticagrelor in the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2011;32(23):2933–44. https://doi.org/10.1093/eurheartj/ehr422.

        Article  CAS  PubMed  Google Scholar 

      32. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease. Circulation. 2009;120(25):2577–85. https://doi.org/10.1161/CIRCULATIONAHA.109.912550.

        Article  CAS  PubMed  Google Scholar 

      33. • Group ES, Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006;367(9523):1665–73. https://doi.org/10.1016/S0140-6736(06)68734-5. Seminal trial investigating stroke recurrece and major bleeding risks using aspirin and extended release dipyridamole as DAPT.

        Article  Google Scholar 

      34. • Kwon SU, Hong KS, Kang DW, Park JM, Lee JH, Cho YJ, et al. Efficacy and safety of combination antiplatelet therapies in patients with symptomatic intracranial atherosclerotic stenosis. Stroke. 2011;42(10):2883–90. https://doi.org/10.1161/STROKEAHA.110.609370. Trial investigating DAPT with aspirin and cilostazol for intracranial symptomatic stenois.

        Article  CAS  PubMed  Google Scholar 

      35. Hankey GJ. CSPS.com Trial of adding cilostazol to antiplatelet therapy to reduce recurrent stroke. Stroke. 2020;51(2):696–8. https://doi.org/10.1161/STROKEAHA.119.028409.

      36. Shinohara Y, Katayama Y, Uchiyama S, Yamaguchi T, Handa S, Matsuoka K, et al. Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial. Lancet Neurol. 2010;9(10):959–68. https://doi.org/10.1016/S1474-4422(10)70198-8.

        Article  CAS  PubMed  Google Scholar 

      37. • McHutchison C, Blair GW, Appleton JP, Chappell FM, Doubal F, Bath PM, et al. Cilostazol for secondary prevention of stroke and cognitive decline. Stroke. 2020;51(8):2374–85. https://doi.org/10.1161/STROKEAHA.120.029454. Trial investigated long term use of cilostazol, compared with other antiplatelets, for secondary stroke prevention and cogmnitive outcomes.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      38. Jing J, Meng X, Zhao X, Liu L, Wang A, Pan Y, et al. Dual antiplatelet therapy in transient ischemic attack and minor stroke with different infarction patterns: subgroup analysis of the CHANCE randomized clinical trial. JAMA Neurol. 2018;75(6):711–9. https://doi.org/10.1001/jamaneurol.2018.0247.

        Article  PubMed  PubMed Central  Google Scholar 

      39. •• Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. New England Journal of Medicine. 2012;367(9):817–25. https://doi.org/10.1056/NEJMoa1204133. Seminal trial investigating DAPT with aspirin plus clopidogrel for patients with lacunar stroke.

      40. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):993–1003. https://doi.org/10.1056/NEJMoa1105335.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      41. Chimowitz MI, Lynn MJ, Howlett-Smith H, Stern BJ, Hertzberg VS, Frankel MR, et al. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352(13):1305–16. https://doi.org/10.1056/NEJMoa043033.

        Article  CAS  PubMed  Google Scholar 

      42. Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, et al. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85(13):1154–62. https://doi.org/10.1212/WNL.0000000000001972.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      43. • Wong KS, Chen C, Fu J, Chang HM, Suwanwela NC, Huang YN, et al. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol. 2010;9(5):489–97. https://doi.org/10.1016/s1474-4422(10)70060-0. Seminal trial investigating DAPT with aspirin plus clopidogrel for reduction of microemboli signals in patients with symptomatic intracranial stenosis.

        Article  CAS  PubMed  Google Scholar 

      44. Amarenco P, Denison H, Evans SR, Himmelmann A, James S, Knutsson M, et al. Ticagrelor added to aspirin in acute nonsevere ischemic stroke or transient ischemic attack of atherosclerotic origin. Stroke. 2020;51(12):3504–13. https://doi.org/10.1161/strokeaha.120.032239.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      45. • Kwon SU, Cho YJ, Koo JS, Bae HJ, Lee YS, Hong KS, et al. Cilostazol prevents the progression of the symptomatic intracranial arterial stenosis: the multicenter double-blind placebo-controlled trial of cilostazol in symptomatic intracranial arterial stenosis. Stroke. 2005;36(4):782–6. https://doi.org/10.1161/01.STR.0000157667.06542.b7. Trial showeing the benefits of cilostazol in patients with acute intracranial symptomatic stenosis.

        Article  CAS  PubMed  Google Scholar 

      46. Wang Y, Chen W, Lin Y, Meng X, Chen G, Wang Z, et al. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. BMJ. 2019;365: l2211. https://doi.org/10.1136/bmj.l2211.

        Article  PubMed  PubMed Central  Google Scholar 

      47. Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, et al. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018;391(10123):850–9. https://doi.org/10.1016/S0140-6736(17)32849-0.

        Article  CAS  PubMed  PubMed Central  Google Scholar 

      48. Brown DL, Levine DA, Albright K, Kapral MK, Leung LY, Reeves MJ, et al. Benefits and risks of dual versus single antiplatelet therapy for secondary stroke prevention: a systematic review for the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack. Stroke. 2021;52(7):e468–79. https://doi.org/10.1161/STR.0000000000000377.

        Article  PubMed  Google Scholar 

      49. Li ZX, Xiong Y, Gu HQ, Fisher M, Xian Y, Johnston SC, et al. P2Y12 Inhibitors plus aspirin versus aspirin alone in patients with minor stroke or high-risk transient ischemic attack. Stroke. 2021;52(7):2250–7. https://doi.org/10.1161/STROKEAHA.120.033040.

        Article  CAS  PubMed  Google Scholar 

      50. Bhatia K, Jain V, Aggarwal D, Vaduganathan M, Arora S, Hussain Z, et al. Dual antiplatelet therapy versus aspirin in patients with stroke or transient ischemic attack: meta-analysis of randomized controlled trials. Stroke. 2021;52(6):e217–23. https://doi.org/10.1161/STROKEAHA.120.033033.

        Article  CAS  PubMed  Google Scholar 

      51. Medranda GA, Zhang C, Doros G, Yerasi C, Case BC, Weintraub WS, et al. Meta-analysis of usefulness of antiplatelet therapy in ischemic stroke or transient ischemic attack. Am J Cardiol. 2021;153:129–34. https://doi.org/10.1016/j.amjcard.2021.05.028.

        Article  CAS  PubMed  Google Scholar 

      52. Fu-Sang W, Xiao-Han Z, Yang Z, Ting-Ting C, Chao S, Jing-Yi L, et al. Efficacy and safety of dual versus mono antiplatelet therapy in patients with stroke or transient ischemic attack: an updated meta-analysis of 18 randomized controlled trials. Pharmazie. 2020;75(10):516–23. https://doi.org/10.1691/ph.2020.0683.

        Article  CAS  PubMed  Google Scholar 

      53. Pugliese F, Arasaratnam P, Moellenberg M, Dani S. Short- vs. long-term dual antiplatelet therapy in secondary prevention for ischaemic stroke: a network metanalysis. European Heart Journal - Quality of Care and Clinical Outcomes. 2019;5(4):298–309. https://doi.org/10.1093/ehjqcco/qcz024.

      Download references

      Author information

      Authors and Affiliations

      1. Department of Neurology and Rehabilitation, University of Illinois College of Medicine, 912 S. Wood Street, M/C 796, 172C, Chicago, IL, 60612, USA

        Gabriela Trifan MD, Fernando D. Testai MD, PhD & Philip B. Gorelick MD, MPH

      Authors
      1. Gabriela Trifan MD
        View author publications

        You can also search for this author in PubMed Google Scholar

      2. Fernando D. Testai MD, PhD
        View author publications

        You can also search for this author in PubMed Google Scholar

      3. Philip B. Gorelick MD, MPH
        View author publications

        You can also search for this author in PubMed Google Scholar

      Ethics declarations

      Conflict of Interest

      Dr. Gorelick has served as a member of a steering committee for a clinical trial of aspirin in first stroke and other primary cardiovascular prevention and has been a member of major cardiovascular event adjudication committees for AstraZeneca-sponsored studies. Dr. Testai receives private donations from Louis and Christine Friedrich. Dr. Trifan has nothing to disclose.

      Additional information

      Publisher's Note

      Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

      This article is part of the Topical Collection on Cerebrovascular Disorders

      Rights and permissions

      Reprints and permissions

      About this article

      Check for updates. Verify currency and authenticity via CrossMark

      Cite this article

      Trifan, G., Testai, F.D. & Gorelick, P.B. Dual Antiplatelet Therapy in Ischemic Stroke Prevention: Which Two Could Be Better than One?. Curr Treat Options Neurol 23, 39 (2021). https://doi.org/10.1007/s11940-021-00694-0

      Download citation

      • Accepted:

      • Published:

      • DOI: https://doi.org/10.1007/s11940-021-00694-0

      Keywords

      Search

      Navigation