Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke "TARDIS"

Recruiting

Phase N/A Results N/A

Eligibility Criteria

Inclusion Criteria

Adults at high risk of recurrent ischaemic stroke: 1. Acute non-cardioembolic ischaemic stroke (<48 hours of onset). All strokes must have motor weakness or dysphasia at the time of randomisation.2. Acute TIA (<48 hours of onset) with one or more of: crescendo TIA (>1 TIA within 1 week), and/or admitted on dual antiplatelet therapy (aspirin/dipyridamole, aspirin/clopidogrel, clopidogrel/dipyridamole), and/or with an ABCD2 score >4. All TIAs must have motor weakness and/or dysphasia lasting at least 10 minutes.3. Meaningful consent, or consent from a relative, carer or legal representative if the patient is unable to give meaningful consent (e.g. in cases of dysphasia, confusion, or reduced conscious level).

Exclusion Criteria

1. Age<50; 2. Motor weakness or dysphasia lasting <10 minutes; 3. Pure sensory, vertigo or dizziness, speech or visual disturbance symptoms without weakness or dysphasia; 4. Patients with contraindications to, or intolerance of, aspirin, clopidogrel or dipyridamole; 5. Patients with definite need for treatment with clopidogrel (e.g. recent MI) 6. Pre-morbid dependency (mRS>2); 7. No enteral access; 8. Parenchymal haemorrhagic transformation (PH I/II), subarachnoid haemorrhage or other non ischaemic cause for weakness; 9. TIA not fulfilling inclusion criteria10. Definite need for full dose oral (e.g. warfarin) or parental (e.g. heparin or glycoprotein IIb IIIa inhibitors) anti-coagulation. NB Low dose heparin for DVT prophylaxis is allowed.11. Received thrombolysis within the last 30 hours;12. Presumed cardioembolic stroke (e.g. AF, recent MI, or other conditions need for anticoagulation);13. Severe high BP (BP>185/110 mmHg);14. Known haemoglobin less than 10g/dL15. Known platelet count less than 100 x 109 /L16. Known white cell count less than 3.5 x 109 /L17. Bleeding within 1 year (e.g. peptic ulcer, intracerebral haemorrhage); 18. Planned surgery during 3 month follow-up (e.g. carotid endarterectomy).19. Concomitant acute coronary syndrome;20. Stroke secondary to a procedure (e.g. carotid or coronary intervention);21. Coma (GCS<8)22. Non-stroke life expectancy<6 months;23. Dementia24. Participation in another drug trial concurrently or within 30 days. (Patients may be randomised into observational studies or non-drug trials)25. Not available for follow-up e.g. no fixed address, overseas visitor26. Females of childbearing potential, pregnancy or breastfeeding[Note: Clopidogrel will be stopped around procedures that become necessary after enrolment].