Although most studies showed some increase in bleeding risk with DAPT, this was offset by the stroke prevention benefit if limited to short- 4. The use of ticagrelor (180-mg loading dose, then 90 mg twice daily) plus aspirin (300- to 325- mg loading does, then 75 100 mg daily) for 30 days was shown in the THALES trial to be slightly superior to aspirin alone in preventing recurrent stroke (recurrent stroke rate, 5% versus 6.3%; P=0.004) but was also associated with signifi- cantly increased risk of severe bleeding (0.5% ver- ICH was also significantly increased among the DAPT group (0.4% versus 0.1%; P=0.01), and significantly more patients in the DAPT group discontinued treatment because number needed to treat to prevent 1 primary out- come event was 92, and the number needed to harm was 263 for severe bleeding. Further study of this DAPT combination is needed to fully evaluate benefit and risk and to determine whether there is a specific subgroup most likely to benefit. The use of ticagrelor alone compared with aspirin was not associated with any reduction in cardiovascu- The use of ticagrelor plus aspirin for the subgroup of patients with ipsilateral carotid artery stenosis and intracranial stenosis is dis- cussed in Section 5.1.1, Intracranial Large Artery 5. No randomized trials have focused on the ques- tion of changing long-term antiplatelet therapy for the prevention of recurrent stroke. A meta-analysis suggested that, among the 4 studies that exam- ined stroke outcomes, there was a reduced risk of among patients who switched from 1 antiplatelet agent to another or to DAPT.800 However, both of the RCTs that specifically examined recur- rent stroke used DAPT rather than switching antiplatelets. 