Evidence is increasing of the benefits, without increased risks, of using dual antiplatelet therapy – aspirin and clopidogrel – as soon as possible and continued for up to 3-months in patients with minor acute ischaemic stroke or transient ischaemic stroke (TIA), so-called mini-strokes.

The evidence is derived from multiple randomised controlled trials, including a recent large-scale study undertaken in China, the CHANCE trial. As many such patients have their symptoms due to blockage of blood vessels in the brain as a complication of ‘unstable’ ulcerated atheromatous plaques in the blood vessels, either external or internal to the brain, double therapy likely produces a powerful effect on the platelets to reduce their natural aggregation or clumping in response to the plaque.

While more research is needed to better define the types of patients who have the most to gain from such treatment, current evidence is strong for the use of dual antiplatelet therapy as the standard of care in this patient group.