Post-intervention dual antiplatelet therapy for mild stroke

Prior treatment

• Concomitant use of medication with a clinically relevant interaction with ASA or clopidogrel without a therapeutic alternative (e.g., omeprazole, if switching to pantoprazole is not possible)
• Contraindication to MRI (non-MRI-compatible pacemaker, implants)
• Simultaneous participation in another interventional clinical trial (within the last 4 weeks before enrollment)
• Indication for dual antiplatelet therapy for more than 21 days

Other illness

• Evidence of intracerebral bleeding of any kind (except intracerebral bleeding of category HI1 according to the Heidelberg classification) on cerebral imaging 12-24 hours after IVT and/or EVT
• Planned, non-postponable surgery with a foreseeable need to pause antiplatelet therapy (e.g. symptomatic extracranial carotid stenosis with stent implantation or endarterectomy) Acute malignant MCA infarction
• Current Malignant Media Infarction
• Known HIV infection
• Hypersensitivity to ASA, clopidogrel, any of their ingredients, or to drugs with a similar chemical structure
• Addiction or other conditions that do not allow to assess the nature, significance, and possible consequences of the clinical trial
• History of non-traumatic intracranial bleeding
• Major bleeding in the recent 5 years (including traumatic intracranial bleeding)
• Clinically relevant non-major bleeding in the last 3 months
• Any indication for therapeutic anticoagulation at therapeutic dosage with phenprocoumon, heparin, apixaban, rivaroxaban, edoxaban, dabigatran (e.g. atrial fibrillation, mechanical heart valve, deep vein thrombosis)
• Contraindication to dual antiplatelet therapy (e.g. coagulation disorders with increased bleeding tendency)

Lab values

• INR > 1.5 or platelet count < 100,000/mm³ or ALT ≥ 3 times the upper limit of normal or creatinine ≥ 2 times the upper limit of normal
• Woman of childbearing potential, unless at least one of the following criteria is met: a. Postmenopausal (12 months of natural amenorrhea or 6 months of amenorrhea with serum FSH > 40 U/ml), b. Postoperative (6 weeks after bilateral oophorectomy with or without hysterectomy or bilateral salpingectomy), c. Regular and correct use of a contraceptive method with a failure rate < 1 % per year, d. Sexual abstinence, e. Vasectomy of the partner

Other

• At the time of admission to hospital: ASPECT Score < 5 or diffusion weighted imaging (DWI) lesion > 50% of MCI territory in cMRI
• Life expectancy < 1 year
• Indications that the patient is unlikely to comply with the study protocol
• Pregnant or breastfeeding women
• Patients dependent on the sponsor, principal investigator, or study team staff
• Contraindication to ASA or clopidogrel according to the current summary of product characteristics

• Patients of any sex aged ≥ 18 years
• AIS treated with IVT (alteplase or Tenecteplase), and/or EVT AND with a post-interventional NIHSS ≤ 7 points (last documented value prior to randomization)
• Ability to receive oral or nasogastric drug administration
• Written informed consent of the patient