A doctor, usually a neurologist, can also use this treatment for a mild cerebral infarction. With this so-called minor stroke there are minor signs of failure that do not fully recover.
With this amendment, the NHG adheres to the guideline Cerebral infarction and cerebral hemorrhage of the Dutch Neurology Association from 2019. Dual site inhibition consisting of acetylsalicylic acid combined with a P2Y12 inhibitor, such as clopidogrel, is often more effective than monotherapy because of the synergistic effect on inhibiting platelet aggregation.
Research shows that, compared to monotherapy, this approach reduces the risk of a subsequent stroke in patients with a mild stroke or high-risk TIA. The risk of major bleeding is probably increased, but the absolute number of bleeding is small. Therefore, for most patients, the benefits of the treatment outweigh the drawbacks.
It is important that the patient starts treatment within 24 hours of the onset of withdrawal symptoms and continues therapy for a maximum of three weeks. After this period, the working group recommends transferring the patient to clopidogrel monotherapy or a combination treatment of dipyridamole with acetylsalicylic acid or carbasalate calcium.
Restart platelet aggregation inhibitors
A new policy is also that patients can (re)start platelet aggregation inhibitors after an intracerebral haemorrhage while taking antithrombotics. Platelet aggregation inhibitors probably do not lead to a higher risk of recurrent intracerebral haemorrhage.
The extent to which this has a positive effect on the individual patient depends, among other things, on patient factors. The neurologist will make the decision whether or not to start during the admission.
DOAC policy unchanged
Direct-acting oral anticoagulants (DOACs) policy has remained unchanged. In addition to vitamin K antagonists, these agents are still indicated after a TIA or cerebral infarction due to atrial fibrillation. The patient starts this immediately or within fourteen days after the stroke. If not started immediately, the first period must be bridged with a platelet aggregation inhibitor.
DOACs are as effective as vitamin K antagonists in preventing thromboembolic events and death in patients with atrial fibrillation, according to the NHG. The working group does indicate that it still has some concerns about possible extra gastrointestinal bleeding in people over 75.