Does clopidogrel with aspirin compared to aspirin alone given in the first 24 hours after a high-risk transient ischemic attack or minor ischemic stroke reduce recurrent stroke and death?

BEEM Bottom Line

Why is this study important?

Why is this guideline and at least some of its recommendations important? Following a minor stroke or high-risk transient ischemic attack (TIA), patients face an increased risk of recurrent ischemic event. The dual antiplatelet therapy (DAPT) of aspirin (ASA) and clopidogrel appears to synergistically inhibit platelet aggregation. Hence DAPT might be much more effective at preventing recurrent stroke than either agent alone, although this is also more likely to increase the risk of bleeding. Patients who have suffered a major or severely debilitating stroke are at high risk of hemorrhage in that same area, so the potential harm of DAPT in this population will likely outweigh any benefit. Following minor stroke or high-risk TIA; however, the benefits and harms of DAPT on the outcomes of death, non-fatal stroke, major extracranial bleeding, functional ability, and quality of life have been the focus of intensive research.[1] [2]

Which, if any, threats to validity are most likely to have an impact on the results and how?

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