01/08/2025
⏳ Duration of Antiplatelet + Anticoagulant in Neurology
1. 🧠 Atrial Fibrillation + Recent Stroke + Coronary Stent
Triple therapy (OAC + aspirin + clopidogrel):
0–1 week (up to 1 month in high stent thrombosis risk)
Dual therapy (OAC + clopidogrel):
Up to 12 months
Then OAC alone (lifelong)
> 🧠 If stroke is large, delay combo until day 7–14 to reduce hemorrhagic transformation risk.
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2. 🫀 Mechanical Heart Valve + Stroke + CAD
Warfarin + low-dose aspirin:
Lifelong, only if high atherosclerotic risk
If not high-risk CAD: Warfarin alone preferred
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3. 🧬 Antiphospholipid Syndrome (APS) + Arterial Stroke
Warfarin + aspirin:
Consider long-term in high-risk APS (triple-positive) with recurrent events
Otherwise: Warfarin alone is standard
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4. 🩺 After PFO Closure
Dual antiplatelet (aspirin + clopidogrel):
1–6 months
Then aspirin alone:
Up to 5 years or lifelong
> Some cardiologists use aspirin + anticoagulant for 3–6 months if underlying embolic source still exists.
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5. 🧠 Intracranial Atherosclerosis + Stroke + AF
Dual therapy (OAC + antiplatelet):
Short-term (up to 30 days) if high-grade symptomatic stenosis
Then OAC alone, unless recurrent events
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❗ Avoid Prolonged Combo Unless:
There's active CAD, recent MI/stent, or complicated APS
Bleeding risk is low
Stroke size is small
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🧠 Clinical Tip:
> Triple therapy (OAC + dual antiplatelet) is rarely needed beyond 7–30 days,
and dual therapy (OAC + single antiplatelet) is often limited to ≤12 months.
