In 2013 the CHANCE trial demonstred in patients with TIA or stroke minor (NIH <4)  that administration of dual antiplatelet therapy (clopidogrel + ASA) was more effective than the alone (AAS) to prevent recurrence of stroke within 90 days  with safety and low risk of bleeding. Click here to check article CHANCE TRIAL

   It is the only study published so far that it shows some benefit of dual antiplatelet therapy in stroke. Previous studies as MATCH and CHARISMA failed to show little benefit of dual antiplatelet therapy that counteratcts with high risk of bleeding. SOCRATES (ticagrelol and aspiring failed to show benefit of ticagrelol)

  After this study was assessed in certain areas if the patient with dual antiplatelet deserve  it in subacute phase of stroke. However, the study was exclusively conducted in  Chinese population  without apparent previous vascular studies like cervical ecography. Also the control of other vascular risk factors after the event is not well established in the article.

  For all this it seems therefore prudent to recommend dual antiplatelet therapy in patients with recurrent stroke or TIA despite being already with antiplatelet therapy, or in cases of intracranial stenosis orsevere atherotrombotic plaques in carotid ecography.

Another possibility of dual antiplatelet therapy could be the patient with a TIA or minor stroke where it is not possible to perform a vascular study within 48 hours.  But in our center  the cervical ultrasound is performing in emergency assistance to a patient with a TIA or stroke to detect severe carotid stenosis.

Another interesting issue is what to do when a patient has a stroke and the patient is already antiplatelet. Upload dose of 100-300 mg is an option and another would change to another antiplatelet another type mechanism of action as clopidogrel.

   Perhaps this last option is the rightest option if we suspect a stroke patient and take correctly antiplatelet medication Y. It appears that doses of 100 mg are already effective in blocking the effect of platelet since their action at spleen-portal system, and doses greater than 100 mg allow better blocking its antiplatelet effect but get major effect systemically with the likely appearance undesirable effect of antiplatelet agents. But when we prescribe antiplatelet  to secondary prevention, after previous stroke, we prefer aspirine 300 mg due to immediate effect ot its action and extensive effect.