Clinical trial - DAPT
Antiplatelet agents
Aspirin
- acetylation of COX-1
- onset of action after loading dose: 20 min
- time to platelet function recovery after drug cessation: 5-7 days
Clopidogrel
- irreversible P2Y12 antagonist
- onset of action after loading dose: 2-6 h
- time to platelet function recovery after drug cessation: 7 days
Ticagrelor
- reversible P2Y12 antagonist
- onset of action after loading dose: 30 min
- time to platelet function recovery after drug cessation 7-10 days
Clinical trials
Minor stroke or high-risk TIA
CHANCE (2013)
- DAPT (clopidogrel 300/75 & ASA) is superior to ASA monotherapy
- chinese population
POINT (2018)
- DAPT (clopidogrel 600/75 & ASA) is superior to ASA monotherapy
- non-chinese population
THALES (2020)
- DAPT (ticagrelor & ASA) is superior to ASA monotherapy
TARDIS (2017)
- triple therapy (clopidogrel & ASA & dipyridamole) causes too many bleedings
INSPIRES (2023)
- DAPT (clopidogrel 300/75 & ASA) is superior to ASA monotherapyLong-term DAPT
MATCH (2004)
- long-term DAPT (clopidogrel & ASA) is inferior to clopidogrel monotherapy
CSPS (2019)
- long-term ASA/clopidogrel & cilostazol is superior to ASA/clopidogrel monotherapy
- lower bleeding risk
Monotherapy
CSPS 2 (2010)
- cilostazol has the same benefit as ASA for non-CE stroke
SOCRATES (2015)
- ticagrelor has the same benefit as ASA
Mild to moderate ischemic stroke
ATAMIS (2024)
- DAPT (clopidogrel 300/75 & ASA) is superior to ASA monotherapy
Minor non-disabling stroke
ARAMIS (2023)
- DAPT (clopidogrel 300/75 & ASA) same to tPA
ICAD
SAMMPRIS (2011)
- Medical therapy is superior to intra-cranial stenting
