Real-world use of aspirin–clopidogrel dual antiplatelet therapy after acute non-cardioembolic ischemic stroke: concordance with trial-based criteria and in-hospital bleeding events

Objective To describe real-world prescribing patterns of aspirin plus clopidogrel dual antiplatelet therapy (DAPT) in patients with acute non-cardioembolic ischemic stroke, assess concordance with selected time-window and stroke-severity criteria derived from the CHANCE and POINT trials. Methods This single-center retrospective cross-sectional study included 607 patients hospitalized with acute non-cardioembolic ischemic stroke between September 2023 and May 2025. Clinical characteristics, antiplatelet prescribing patterns, concordance with selected trial-derived criteria, and in-hospital bleeding events were assessed using data from the index hospitalization. Results Among the 607 patients, 522 (86.0%) received aspirin–clopidogrel DAPT. Of these, 197 (37.7%) received a 300-mg clopidogrel loading dose. Overall, 124 patients (20.4%) met the selected CHANCE-based criteria and received DAPT with a clopidogrel loading dose, whereas 93 (15.3%) met the corresponding POINT-based criteria and received the same treatment. Additionally, 413 patients (68.0%) met the exploratory extended definition (onset-to-door time ≤ 72 h and NIHSS score ≤ 5), of whom 380 (92.0%) received DAPT and 33 (8.0%) did not. Three in-hospital bleeding events (0.5%) were documented, including two among DAPT recipients. No intracranial or fatal bleeding was recorded. Conclusions Aspirin–clopidogrel DAPT was frequently prescribed to patients who did not meet selected NIHSS and time-window criteria derived from pivotal trials, while use of a clopidogrel loading dose was limited. Few in-hospital bleeding events were observed, and the retrospective study design preclude definitive conclusions regarding the safety of DAPT beyond trial-based populations. Greater standardization of DAPT prescribing and loading-dose practices is warranted.