Effect of a regional guideline-education initiative on dual antiplatelet therapy use in minor non-cardioembolic stroke: a pre–post analysis from the Shanghai Stroke Service System

BACKGROUND: Dual antiplatelet therapy (DAPT) reduces recurrent stroke in patients with minor non-cardioembolic ischaemic stroke or high-risk transient ischaemic attack (TIA). However, real-world prescribing remains heterogeneous. The Shanghai Stroke Service System (4S) initiated a guideline-focused education and audit-feedback programme aimed at improving standard DAPT use for minor strokes since 2019. This study evaluates its impact on the adherence to DAPT and clinical outcomes before and after this initiative. METHODS: score ≥4) between 2015 and 2021 were enrolled. Patients with suspected cardioembolism or who received intravenous thrombolysis were excluded. Standard DAPT was defined as aspirin plus clopidogrel initiated within 24 hours. Education throughout the 4S on the use of DAPT was carried out during 2018-2019. Outcomes during postimplementation period (2019-2021) were compared with preimplementation period (2015-2018). The primary outcome was standard DAPT rate; secondary outcomes included in-hospital stroke recurrence and non-standard DAPT. RESULTS: Among 58 491 patients, standard DAPT increased by 13.6% (95% CI 12.8 to 14.4; p