Regarding secondary prevention of ischemic stroke, all of the following statements are true EXCEPT:

## Secondary Prevention of Ischemic Stroke: Evidence-Based Strategies ### Key Point: **Dual antiplatelet therapy (DAPT) is NOT superior to monotherapy for long-term secondary prevention in all stroke patients.** DAPT is reserved for acute coronary syndrome and specific high-risk acute stroke scenarios (e.g., minor stroke/TIA within 24 hours); for chronic secondary prevention, monotherapy is standard. ### High-Yield Antiplatelet Strategies: | Strategy | Indication | Evidence | |----------|-----------|----------| | **Aspirin monotherapy** | First-line for non-cardioembolic stroke | CAST, IST trials; NNT ~67 to prevent 1 recurrent stroke | | **Clopidogrel monotherapy** | Alternative to aspirin; similar efficacy | CAPRIE trial | | **DAPT (aspirin + clopidogrel)** | Acute stroke/TIA <24 hrs (POINT, CHANCE trials) | Reduces early recurrence; NOT used long-term | | **Aspirin + extended-release dipyridamole** | Alternative combination | ESPS-2 trial; modest benefit over aspirin alone | ### Clinical Pearl: **POINT Trial (2018):** Dual antiplatelet therapy (aspirin + clopidogrel) for 90 days reduced recurrent stroke in **acute minor stroke/TIA within 24 hours**, but this is NOT extended to all chronic stroke patients due to bleeding risk. ### Why Each Option Is Correct (Except the Answer): - **Option 0 (correct):** Aspirin 75–325 mg daily is guideline-recommended first-line monotherapy for non-cardioembolic ischemic stroke [cite:AHA/ASA Guidelines]. - **Option 2 (correct):** SPS3 and other trials show that BP targets <130/80 mmHg reduce recurrent stroke by ~20–30% in hypertensive patients post-stroke. - **Option 3 (correct):** Statins reduce recurrent stroke and cardiovascular events in all stroke patients (SPARCL trial), independent of baseline LDL; high-intensity statin therapy is recommended. - **Option 1 (WRONG):** DAPT is **NOT** superior to monotherapy for **long-term** secondary prevention. It is used only in acute settings (minor stroke/TIA <24 hrs). Chronic DAPT increases bleeding risk without additional stroke benefit. ### Mnemonic for Stroke Secondary Prevention: **ABCDE** — (A)ntiplatelet (aspirin/clopidogrel), (B)lood pressure control, (C)ardiac risk factors (AFib screening, echocardiography), (D)iabetes management, (E)xercise and lifestyle. ### Warning: ~~Dual antiplatelet therapy for all stroke patients~~ — This is a common misconception. DAPT is acute/short-term only; long-term monotherapy is standard. [cite:Harrison 21e Ch 379; AHA/ASA Stroke Guidelines 2019]