Abstract Body: Introduction: Patients with transient ischemic attack (TIA) or minor ischemic stroke are at a high risk of recurrent stroke and neurological deterioration. Dual antiplatelet therapy (DAPT) of clopidogrel or ticagrelor has been used in these patients, however, the timing of DAPT administration from the onset of symptoms is unclear. We aimed to assess the timing of DAPT administration compared to aspirin in these patients.

Methods: We searched PubMed, Scopus, Web of Science, and the Cochrane Library for relevant Randomized Controlled Trials (RCTs) addressing the timing of DAPT administration in patients with TIA or minor stroke compared to aspirin from inception until April 2024. Primary outcomes were the incidence of recurrent stroke and major bleeding. Dichotomous data were pooled as Odds Ratio (OR) with its corresponding 95% Confidence Interval (CI) using a random-effect model.

Results: Twelve RCTs comprising 45,661 patients (22,827 in DAPT, and 22834 in aspirin) were included in the final analysis. Administration of DAPT within 24 hours or 72 hours was associated with a lower risk of recurrent stroke, with the following values, respectively (OR: 0.8, 95% CI: 0.73 to 0.88, p <0.001, and 0.6, 95% CI: 0.41 to 0.87, p =0.01). However, administration of DAPT within 24 hours was associated with a higher risk of major bleeding (OR: 1.83, 95% CI: 1.12 to 3.01, p =0.02), with no significant difference when administrated within 72 hours (OR: 1.54, 95% CI: 0.88 to 2.7, p= 0.13).

Conclusion: Administration of DAPT within 72 hours from symptoms of TIA was associated with reduced incidence of recurrent stroke and without significant impact on major bleeding. On the other hand, 24-hour administration time was associated with a higher risk of major bleeding. Further RCTs with 72 hours administration time are warranted to validate these results.