Adherence to Dual Antiplatelet Therapy Protocol in Acute Ischemic Stroke

Previous randomized trials, such as CHANCE and POINT, have shown that dual antiplatelet therapy (DAPT) reduces ischemic event recurrence. However, its effectiveness depends on accurate dosage and timely administration. This study is a comprehensive quality assessment of the implementation of the DAPT protocol-specifically, treatment initiation within 48 h of symptom onset in patients with mild stroke or high-risk TIA-at our center.

For this single-center, retrospective analysis we screened all 11,180 consecutive patients from the Helsinki Stroke Quality Registry (HSQR) treated at the emergency department between 1st of January 2019 and 25th of January 2023. Patients with DAPT (ASA and clopidogrel) within 2 weeks of admission were included. Patients treated with i.v. thrombolysis, thrombectomy or if already on DAPT prior to admission were excluded. We analyzed the time of DAPT initiation, patient diagnoses and risk scores (NIHSS and ABCD²).

Of 11,180 patients screened, 299 met the inclusion criteria. Among them, 263 (88.0%) had a final diagnosis of ischemic stroke or TIA, supporting DAPT use. Risk scores were documented in 193 (73.4%), and 197 (65.9%) initiated DAPT within 48 h of symptom onset per our institutional protocol. Overall, 137 (45.8%) fully adhered to all protocol criteria.

Fewer than half (45.8%) of patients fully adhered to the HUS protocol, and 65.9% initiated DAPT within 48 h from symptom onset. We propose that DAPT should be considered as part of the acute stroke treatment protocol for eligible patients to minimize delays in treatment initiation.