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Minor Stroke – DAPT (CHANCE/POINT) — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseMinor Stroke – DAPT (CHANCE/POINT)SCE Neurology

A 50-year-old man presents with a minor ischaemic stroke (NIHSS 3) due to symptomatic intracranial atherosclerosis of the left MCA. He is beyond the thrombolysis window. Per the CHANCE and POINT trials, what is the recommended acute antiplatelet strategy?

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Reveal the answer and explanation

Correct answer: B — Dual antiplatelet therapy (aspirin and clopidogrel) for 21 days, followed by single antiplatelet therapy

Explanation lettering: C = shown as B · B = shown as C · E = shown as D · D = shown as E

The CHANCE and POINT trials demonstrated that short-course dual antiplatelet therapy (DAPT — aspirin 300 mg loading then 75 mg daily PLUS clopidogrel 300 mg loading then 75 mg daily) for 21 days followed by single antiplatelet therapy reduces the risk of recurrent stroke after minor ischaemic stroke or high-risk TIA compared with aspirin alone, without a significant increase in major haemorrhage. This is now standard practice for non-cardioembolic minor stroke/TIA. A/B: Single antiplatelet alone is inferior in the acute phase. D: Triple therapy increases bleeding. E: Anticoagulation is for cardioembolic stroke.

Reference: CHANCE Trial (2013); POINT Trial (2018); RCP National Clinical Guideline for Stroke (2023)