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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Extending Dual Antiplatelet Therapy Beyond 3 Months in Acute Ischemic Stroke Due to Large-Artery Atherosclerosis

Minwoo Lee1, Mi-Sun Oh1, Kyung-Ho Yu1

  • 1Department of Neurology Hallym University Sacred Heart Hospital Anyang-si Republic of Korea.

Journal of the American Heart Association
|December 3, 2025
PubMed

Insights

Dual antiplatelet therapy (DAPT) duration for acute ischemic stroke from large-artery atherosclerosis has increased. Continuing DAPT beyond 3 months offers clinical benefits without raising bleeding risk.

Area of Science:

  • Cardiology
  • Neurology
  • Clinical Pharmacy

Background:

  • Optimal duration of dual antiplatelet therapy (DAPT) for acute ischemic stroke due to large-artery atherosclerosis is not well-defined.
  • Aspirin plus clopidogrel is a common DAPT regimen.
  • Large-artery atherosclerosis is a significant cause of ischemic stroke.

Purpose of the Study:

  • To evaluate trends in DAPT duration for acute ischemic stroke patients.
  • To assess the clinical outcomes associated with extended DAPT.
  • To determine if longer DAPT duration increases bleeding risk.

Main Methods:

  • Retrospective analysis of a prospective, multicenter stroke registry (2011-2018) linked to a national health insurance claims database.
  • Inclusion criteria: acute ischemic stroke, large-artery atherosclerosis, DAPT initiation within 48 hours, no primary outcome events in the first 30 days.
  • Landmark analyses assessed DAPT continuation up to 6 months; primary outcome: recurrent stroke, myocardial infarction, major bleeding, all-cause death within 1.5 years.

Main Results:

  • Median DAPT duration increased from 36 days (2011) to 122 days (2018).
  • Continuing DAPT beyond 3 months reduced the primary outcome risk (aHR 0.78 [95% CI, 0.64-0.94] at 3 months; 0.78 [95% CI, 0.61-0.98] at 6 months).
  • DAPT continuation did not significantly increase stroke recurrence or major bleeding but reduced all-cause death.

Conclusions:

  • DAPT duration for acute ischemic stroke due to large-artery atherosclerosis has lengthened over time.
  • Continuation of DAPT beyond 3 months appears to provide net clinical benefits.
  • Extended DAPT does not increase the risk of major bleeding in this patient population.
Abstract

Keywords:
antiplatelet agentsdeathdual antiplatelet therapyischemic strokelarge‐artery atherosclerosisstroke recurrence

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