Relatively few head-to-head compari- sons of antiplatelet medications have been evaluated for the prevention of recurrent stroke, and in the existing trials, the benefit of 1 medication over another is small. Despite the common practice of changing antiplate- let medications in patients already taking 1 medication at the time of stroke, there is relatively little evidence from RCTs to support the benefit of this practice. Finally, although DOACs may be beneficial in vascular event reduction in patients with stable CVD (COMPASS [Cardiovascular Outcomes for People Using Antico- whether they have any role in secondary stroke prevention for patients with recent noncardioembolic stroke remains an unanswered question. In summary, further research is needed in the following areas: Optimal combination of medications, timing of initia- tion, and duration of DAPT. Effectiveness and potential harm of DAPT among specific subgroups of patients according to stroke characteristics, laboratory or genetic tests, or other factors. Effectiveness/selection of a given antiplatelet agent over another in specific subgroups of patients with noncardioembolic stroke. Benefit of switching antiplatelet agent for patients already taking 1 antiplatelet medication at the time of stroke. Effectiveness of DOACs compared with or in com- bination with antiplatelet therapy for secondary stroke prevention among patients with noncardio- embolic ischemic stroke. 6. SYSTEMS OF CARE FOR SECONDARY PREVENTION 6.1. Health Systems Based Interventions for Secondary Stroke Prevention Recommendations for Health Systems Based Interventions Referenced studies that support recommendations are summarized in online Data Supplements 60 62. COR LOE Recommendations In patients with ischemic stroke or TIA, voluntary hospital-based or outpatient-focused quality monitoring and improvement programs are recommended to improve short-term and long-term adherence to nationally accepted, evidence-based guidelines for secondary stroke prevention. 