is it better to change to clopidogrel or to add clopidogrel or there is another option.
Step one: find out if there is a potential cause for the recurrent stroke, for example, any carotid plague? stenosis in major cerebral branches? atrial fibrillation? moyamoya? etc. If so, eliminate risk factors accordingly
Step two: after ruling out possible risks, discuss with your superior or consultant if dual anti-platelet can be given (aspirin plus clopidopgrel); meanwhile control blood pressure, sugar and cholesterol (recommended by ASA to be lower to below the normal range).
Step three: still having incidents after dual anti-platelet, discuss whether or not to give aggressive medical therapy as per SAMPRISE suggest, that is prolonged high dose of anti-platelet (300 mg aspirin and 300 mg clopidoprel per day) as prevention.
What is the timeline of recurrence? If there is a >50% stenosis of the carotid artery, carotid endarterectomy is recommended.
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