| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Aspirin (single-antiplatelet)[1] | Antiplatelet (COX-1 irreversible inhibitor) | 75–325 mg PO daily; lifelong unless intolerant | — | First-line for non-cardioembolic stroke/TIA; combine with PPI if GI bleeding risk |
| Clopidogrel (single-antiplatelet)[1] | P2Y12 receptor antagonist | 75 mg PO daily | — | Alternative when aspirin not tolerated; equivalent efficacy in CAPRIE; rare risk of TTP |
| Aspirin + clopidogrel (short-term DAPT)[1] | Dual antiplatelet therapy | Aspirin 75 mg + clopidogrel 75 mg PO daily for 21 days, then aspirin alone | — | Minor non-cardioembolic stroke (NIHSS ≤3) or high-risk TIA (ABCD2 ≥4) — start within 24 h. POINT and CHANCE trials. Long-term DAPT increases bleeding without benefit |
| Aspirin + ticagrelor (alternative DAPT)[1] | Dual antiplatelet therapy | Aspirin 75 mg + ticagrelor 90 mg BD × 30 days | — | Minor stroke or high-risk TIA per THALES; alternative to clopidogrel-aspirin where clopidogrel non-response or contraindicated |
| Apixaban or rivaroxaban (cardioembolic AF)[1] | DOAC (factor Xa inhibitor) | Apixaban 5 mg BD (2.5 mg if any 2 of: age ≥80, weight ≤60 kg, creatinine ≥1.5 mg/dL); rivaroxaban 20 mg PO daily with food (15 mg if CrCl 15–50) | — | First-line for non-valvular AF; superior or equivalent to warfarin with less ICH; contraindicated in mechanical valve and moderate-severe rheumatic mitral stenosis |
| Atorvastatin or rosuvastatin (high-intensity)[1] | HMG-CoA reductase inhibitor | Atorvastatin 80 mg PO daily; rosuvastatin 20–40 mg PO daily | — | All atherosclerotic stroke; LDL-C target <70 mg/dL; add ezetimibe 10 mg or PCSK9 inhibitor if not at target |
| Antihypertensive (ACEi/ARB ± thiazide ± CCB)[1] | Antihypertensive — combination | Per BP and comorbidities; lower target gradually over weeks; combination over uptitration of single agent | — | Target BP <130/80 for most; <140/90 in selected lacunar stroke without diabetes; ACEi/ARB + thiazide is common backbone |
Aetiology-driven secondary prevention after ischaemic stroke or TIA, including antiplatelet, anticoagulation, lipid, BP, and structural interventions.