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Antiplatelet or anticoagulant treatment if further TIA or ischaemic stroke whilst taking aspirin

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

There is no concensus as to the management of patients in sinus rhythm who have had a further ischaemic stroke or transient ischaemic attack (TIA) whilst on long-term antiplatelet therapy (1,2). Both clopidogrel and aspirin plus dipyridamole MR have similar rates of recurrent stroke (3).

If a person has a further ischaemic stroke or TIA whilst taking antiplatelet therapy, then they should be fully investigated for potential causes of these events. There is no agreement on the best preventive antiplatelet agent for these patients but options include:

  • switching to clopidogrel
  • adding clopidogrel to aspirin
  • switching to warfarin

Continued efforts should be made to reduce a patients general risk factors for stroke.


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