Letter re: Risks and benefits of clopidogrel–aspirin in minor stroke or TIA: Time course analysis of CHANCE

We read with interest the article by Pan et al.,1 which reported that the use of dual antiplatelet therapy (DAPT) showed an early benefit, compared to aspirin alone, for secondary ischemic stroke prevention after a minor stroke or TIA. The absolute risk reduction in the first week after the indexed event was 4.5%.1 The authors previously reported a nonsignificant absolute risk reduction in recurrent ischemic stroke of 2.3% with DAPT compared to aspirin alone in Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE) participants with intracranial arterial stenosis (ICAS) over the 90-day follow-up period.2 In figure 1 from the article by Pan et al.,1 the benefit of DAPT compared with aspirin alone appears greater in the first 2 weeks among those with ICAS, with parallel risk curves thereafter. In this context, it would be valuable if the authors reported the time-course analysis for the risk of ischemic stroke and hemorrhage in the first, second, and third week by ICAS status. These data could help formulate possible mechanism-based interventions for acute stroke, which could then be tested in trials.