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Intensive antiplatelet therapy with three agents does not reduce risk of another stroke
  1. Teck Khong,
  2. James Kimpton
  1. Clinical Pharmacology, St George's University of London, London, UK
  1. Correspondence to Dr Teck Khong,Basic Medical Sciences, St George's University of London, London, UK; tkhong{at}sgul.ac.uk

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Commentary on: Bath PM, Woodhouse LJ, Appleton JP, et al. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet 2018;391:850–9.

Commentary by: Dr James Kimpton and Dr Teck Khong Clinical Pharmacology, St George's, University of London, UK

Series Editor: Dr Teck Khong, DTB Associate Editor Clinical Pharmacology, St George's, University of London, UK

Key learning points

  • In people who have had a stroke or transient ischaemic attack, triple antiplatelet therapy with aspirin, clopidogrel and dipyridamole did not reduce stroke recurrence compared with guideline-based antiplatelet therapy (aspirin and dipyridamole, or clopidogrel alone) but increased the risk of haemorrhage.

  • Intensive antiplatelet therapy with three drugs should not be used in routine clinical practice to prevent recurrent events in patients with acute cerebral ischaemia.

Summary

The Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial showed that among patients with acute, non-cardioembolic ischaemic stroke or transient ischaemic attack (TIA), intensive antiplatelet therapy with three drugs did not reduce the risk and severity of recurrent stroke or TIA, but did increase the risk of major bleeding when compared with guideline-directed antiplatelet therapy.1

Overview

TARDIS was an international, multicentre, prospective, randomised, open-label, blinded end-point, parallel-group superiority clinical trial that …

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