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Ischemic Stroke-Secondary Prevention — ABIM Board MCQ

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HardNeurologyIschemic Stroke-Secondary PreventionABIM Board

A 65-year-old had a minor noncardioembolic ischemic stroke 10 months ago. Evaluation found no atrial fibrillation or other indication for anticoagulation. He completed a short course of aspirin plus clopidogrel and has had no recurrence. Which antithrombotic plan is appropriate now?

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Correct answer: A — Continue long-term therapy with a single antiplatelet agent

The best answer is “Continue long-term therapy with a single antiplatelet agent”. Long-term single antiplatelet therapy is appropriate after noncardioembolic stroke. Short-term DAPT benefits selected early minor-stroke or high-risk-TIA patients, but indefinite DAPT raises bleeding risk without routine added benefit; anticoagulation requires a separate indication.

Reference: 2021 AHA/ASA Guideline for Prevention of Stroke in Patients With Stroke and TIA: https://professional.heart.org/en/science-news/2021-guideline-for-the-prevention-of-stroke-in-patients-with-stroke-and-transient-ischemic-attack