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Ahmed Koriesh: Would You Start DAPT If the Patient Presents After 24 Hours?
Ahmed Koriesh/LinkedIn
Mar 27, 2026, 17:19

Ahmed Koriesh: Would You Start DAPT If the Patient Presents After 24 Hours?

Ahmed Koriesh, Director of Hospital Neurology Service at Cleveland Clinic Florida, shared on LinkedIn:

”Would you start DAPT if the patient presents after 24 hours?

Yes — why not.

The key concept

  • Stroke recurrence risk is front-loaded.
  • Highest risk in the first 3–7 days
  • Then declines significantly

When you look at recurrence curves:
Steep early rise to gradual flattening

Why this matters

  • Early phase equals unstable plaque, high embolic risk
  • This is where DAPT has the greatest impact

Practical take

  • <24h: ideal (trial-based)
  • 24h – several days: still meaningful benefit
  • Approxmately 1 week: diminishing returns

There is no sharp cutoff — it’s a gradient, not a binary window

What about the Trials?

  • Trials (CHANCE/POINT) used ≤24h to maximize efficacy
  • But biology doesn’t stop at 24h
  • Risk – and potential benefit – persists beyond that

Bottom line
If patient present with minor stroke after 24h, still within few days, would still benefit from DAPT to reduce recurrence, specially in high risk patients.”

Ahmed Koriesh: Would You Start DAPT If the Patient Presents After 24 Hours?

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