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.”

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