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. In a subgroup analysis of the SPS3 trial, there was no benefit from the addition of clopidogrel to aspirin among patients with isch- emic stroke who were already taking aspirin (risk of recurrent stroke, 3.1% versus 3.3%; HR, 0.91 In a subgroup of patients already on aspirin in the CHANCE trial, there was a reduction in recurrent stroke among patients with clopidogrel added to aspirin versus aspirin alone A prospective registry study found that maintaining aspirin therapy was associated with higher recur- rent stroke rates (8.0%) compared with switching to another antiplatelet (6.9%) or adding another 6. Long-term use of DAPT with aspirin and clopi- dogrel has been shown in 2 secondary stroke CLINICAL STATEMENTS AND GUIDELINES Kleindorfer to have no benefit over SAPT for recurrent stroke prevention and to have a significantly increased risk of ICH and major bleeding. The exact duration of DAPT at which the risk of hemorrhage begins to outweigh the benefit of stroke prevention is unknown, but meta-analyses report as early as 21,802 or and those with more appear to be at higher risk of ICH with DAPT. 