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DAPT Duration after TIA — SCE Neurology MCQ

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Hard"Neurology"DAPT Duration after TIASCE Neurology

A 58-year-old presents 10 hours after a non-cardioembolic minor ischaemic stroke. Haemorrhage is excluded and bleeding risk is low. She previously had a TIA despite confirmed adherence to clopidogrel, and testing documented CYP2C19 loss of function. Which immediate antiplatelet pathway is the most appropriate alternative?

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Correct answer: D — Load ticagrelor 180 mg plus aspirin 300 mg, then use ticagrelor 90 mg twice daily with aspirin 75 mg for 30 days

The UK National Clinical Guideline for Stroke includes two short-course dual-antiplatelet pathways within 24 hours of eligible minor stroke or TIA. The ticagrelor pathway uses a 180 mg loading dose plus aspirin 300 mg, followed by ticagrelor 90 mg twice daily with aspirin 75 mg for 30 days. It also says to consider clopidogrel resistance after recurrent TIA or stroke on clopidogrel. Therefore documented CYP2C19 loss of function makes reuse of the clopidogrel pathway unattractive here. Prasugrel and ticagrelor monotherapy are not the listed acute regimens, and aspirin followed by dipyridamole omits recommended early dual therapy.

Reference: National Clinical Guideline for Stroke: Acute care. https://www.strokeguideline.org/chapter/acute-care/