ABSTRACT NUMBER: ESOC2026A1399 APPROPRIATENESS OF DUAL ANTIPLATELET THERAPY PRESCRIBING IN A TIA CLINIC: A QUALITY IMPROVEMENT PROJECT

Abstract Background and aims Dual antiplatelet therapy (DAPT) is recommended for selected patients with high-risk transient ischemic attack (TIA) and minor ischemic stroke. Despite national and international stroke guidelines, variation in indication, timing, and rationale for DAPT prescribing persists. This quality improvement project evaluated DAPT use in a TIA clinic and assessed guideline adherence. Methods Two retrospective audit cycles were conducted. The first audit included patients reviewed between December 2024 and May 2025 (n=116). A guideline-based DAPT decision-support flowchart was introduced in August 2025. The second audit included patients seen between September and December 2025 (n=74). Primary outcomes were appropriateness of DAPT indication and duration, antiplatelet therapy at presentation, and time from symptom onset to DAPT initiation. The secondary outcome was DAPT prescribing in central or branch retinal artery occlusion (CRAO/BRAO) and its association with carotid artery disease. Results Clopidogrel was the most used antiplatelet prior to presentation. Median time to DAPT initiation increased from 72 to 96 hours, suggesting persistent clinic-related delays. Across both audits, DAPT was most frequently prescribed for TIA or stroke despite antiplatelet therapy, high-risk TIA and mild ischemic stroke (NIHSS ≤3), while other guideline-supported indications were infrequent. In retinal artery occlusion, >50% carotid stenosis was more common initially, whereas <50% stenosis predominated later. Inappropriate DAPT prescribing increased from 6% to 25% in the second audit. Conclusions Despite implementation, delays in DAPT initiation and variable adherence to guidelines persist, underscoring the need for enhanced clinician awareness. Conflict of interest Moe Pearl Shwe.Nothing to disclose.