Abstract 125: Navigating Uncharted Waters: Dual Antiplatelet in Acute Ischemic Stroke with Recurrent Symptoms Post‐Thrombolysis ‐ An Intriguing Case Report

Abstract Background Current guidelines recommend antiplatelet therapy for secondary stroke prevention following theadministration of tissue plasminogen activator (tPA) in cases of acute ischemic stroke (AIS).However, there is limited guidance on managing early recurrent ischemic stroke after tPAadministration, and this poses a considerable therapeutic challenge in clinical practice.Case.We report the case of a 79‐year‐old right‐handed Caucasian female with recurrent left‐sided motorand sensory deficits, and slurring of speech after Tenecteplase (TNK) administration. She presentedwith left‐sided motor and sensory deficits and slurring of speech, and no profound evidence ofischemia on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Given that her clinical findings were consistent with that of a stroke and symptom onset was within a 4.5‐hour window, IV TNK was safely administered. Afterward, her symptoms resolved completely butrecurred less than a day later. A repeat MRI subsequently showed an acute right pontine infarct. Shewas administered loading doses of Aspirin and Clopidogrel to prevent further progression of thestroke. This was continued as Aspirin 81 mg daily indefinitely and Clopidogrel 75 mg for 21 days.She had a complete resolution of symptoms without symptomatic hemorrhage on follow‐up 30 dayspost‐discharge.Conclusion.Although a single case report, we believe it illustrates a unique approach to a frequent and clinicallyvexing problem in acute stroke management. Dual antiplatelet therapy with aspirin and clopidogrel insymptomatic patients post‐thrombolysis did not result in symptomatic intracranial hemorrhage andshowed good clinical outcomes. The safety and efficacy of dual antiplatelet administration afterthrombolysis in select symptomatic patients warrant further study.