What-Up DAPT!?!

In this episode, we dive into the evidence behind Dual Antiplatelet Therapy (DAPT) for acute secondary prevention, specifically breaking down the landmark CHANCE trial. We also talk about the POINT trial. Here is more on CHANCE. Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack The Question: Does early administration of Aspirin + Clopidogrel reduce the rate of subsequent strokes compared to Aspirin alone? The Population: 5,170 patients ($\ge$ 40 years) with minor ischemic stroke (NIHSS score $\le$ 3) or high-risk TIA (ABCD2 score $\ge$ 4). The Timing: Treatment started within 24 hours of symptom onset. 1. Primary Outcome (Stroke Recurrence at 90 days) DAPT Group: 8.2% Aspirin Monotherapy: 11.7% Result: A significant reduction in stroke risk (HR 0.68; P<0.001). NNT (Number Needed to Treat): 29 2. Safety (Bleeding Risk) DAPT Group: 2.3% Aspirin Monotherapy: 1.6% Result: No statistically significant increase in bleeding rates (P=0.09). In patients with minor ischemic stroke or high-risk TIA, starting Aspirin + Clopidogrel within 24 hours significantly reduces the 90-day stroke incidence without increasing bleeding rates compared to aspirin monotherapy. Reference: Wang Y, et al. NEJM, 2013. 369(1):11-19. (Infographic credit: Visualmed) The Study: CHANCE (2013)Key FindingsBottom Line