Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

doi:10.1136/bmj.k5130

. 2018 Dec 18:363:k5130.

doi: 10.1136/bmj.k5130.

Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

Kameshwar Prasad¹, Reed Siemieniuk^{2

3}, Qiukui Hao^{2

4}, Gordon Guyatt^{2

5}, Martin O'Donnell⁶, Lyubov Lytvyn², Anja Fog Heen⁷, Thomas Agoritsas^{2

8}, Per Olav Vandvik^{7

9}, Sankar Prasad Gorthi¹⁰, Loraine Fisch¹¹, Mirza Jusufovic¹², Jennifer Muller^{13

14}, Brenda Booth¹³, Eleanor Horton¹⁵, Auxiliadora Fraiz, Jillian Siemieniuk¹⁶, Awah Cletus Fobuzi¹⁷, Neelima Katragunta¹⁸, Bram Rochwerg^{19

5}

Affiliations

¹ Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
³ Department of Medicine, University of Toronto, Toronto, Canada.
⁴ The Centre of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Medicine, McMaster University, Hamilton, Canada.
⁶ Deparment of Medicine, NUI Galway, Galway, Ireland.
⁷ Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway.
⁸ Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
⁹ Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
¹⁰ Department of Neurology, Kasturba Medical College, Manipal, India.
¹¹ Division of Neurology, Stroke Centre, University Hospitals of Geneva, Geneva, Switzerland.
¹² Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
¹³ Stroke Foundation of Australia.
¹⁴ School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
¹⁵ School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Maroochydore, Australia.
¹⁶ Peter Lougheed Hospital, Calgary, Canada.
¹⁷ Cochrane Consumers Group.
¹⁸ Department of Surgery, Stanford University, Stanford, California.
¹⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada rochwerg@mcmaster.ca.

PMID: 30563885
DOI: 10.1136/bmj.k5130

Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

Kameshwar Prasad et al. BMJ. 2018.

. 2018 Dec 18:363:k5130.

doi: 10.1136/bmj.k5130.

Authors

Affiliations

¹ Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
³ Department of Medicine, University of Toronto, Toronto, Canada.
⁴ The Centre of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Medicine, McMaster University, Hamilton, Canada.
⁶ Deparment of Medicine, NUI Galway, Galway, Ireland.
⁷ Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway.
⁸ Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
⁹ Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
¹⁰ Department of Neurology, Kasturba Medical College, Manipal, India.
¹¹ Division of Neurology, Stroke Centre, University Hospitals of Geneva, Geneva, Switzerland.
¹² Department of Neurology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
¹³ Stroke Foundation of Australia.
¹⁴ School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
¹⁵ School of Nursing, Midwifery and Paramedicine, University of Sunshine Coast, Maroochydore, Australia.
¹⁶ Peter Lougheed Hospital, Calgary, Canada.
¹⁷ Cochrane Consumers Group.
¹⁸ Department of Surgery, Stanford University, Stanford, California.
¹⁹ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada rochwerg@mcmaster.ca.

PMID: 30563885
DOI: 10.1136/bmj.k5130

Erratum in

Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline.
[No authors listed] [No authors listed] BMJ. 2019 Jan 10;364:l103. doi: 10.1136/bmj.l103. BMJ. 2019. PMID: 30630830 No abstract available.

Abstract

WHAT IS THE ROLE OF DUAL ANTIPLATELET THERAPY AFTER HIGH RISK TRANSIENT ISCHAEMIC ATTACK OR MINOR STROKE? SPECIFICALLY, DOES DUAL ANTIPLATELET THERAPY WITH A COMBINATION OF ASPIRIN AND CLOPIDOGREL LEAD TO A GREATER REDUCTION IN RECURRENT STROKE AND DEATH OVER THE USE OF ASPIRIN ALONE WHEN GIVEN IN THE FIRST 24 HOURS AFTER A HIGH RISK TRANSIENT ISCHAEMIC ATTACK OR MINOR ISCHAEMIC STROKE? AN EXPERT PANEL PRODUCED A STRONG RECOMMENDATION FOR INITIATING DUAL ANTIPLATELET THERAPY WITHIN 24 HOURS OF THE ONSET OF SYMPTOMS, AND FOR CONTINUING IT FOR 10-21 DAYS CURRENT PRACTICE IS TYPICALLY TO USE A SINGLE DRUG.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the BMJ Rapid Recommendations interests disclosure form, and a description of all disclosures is reported in appendix 1 on bmj.com. As with all BMJ Rapid Recommendations, the executive team and The BMJ judged that no panel member had any financial conflict of interest. Professional and academic interests are minimised as much as possible, while maintaining necessary expertise on the panel to make fully informed decisions.

Comment in

Guideline: Starting dual antiplatelet therapy ≤ 24 h after high-risk TIA or minor ischemic stroke is recommended.
Uchino K. Uchino K. Ann Intern Med. 2019 Apr 16;170(8):JC38. doi: 10.7326/ACPJ201904160-038. Ann Intern Med. 2019. PMID: 30986828 No abstract available.

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Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

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Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline

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