Question  What is the time course for benefit and risk with dual antiplatelet therapy for individuals with minor ischemic stroke or transient ischemic attack (TIA) who carry CYP2C19 loss-of-function (LOF) alleles?

Findings  In this secondary analysis of the Ticagrelor or Clopidogrel With Aspirin in High-risk Patients With Acute Nondisabling Cerebrovascular Events II (CHANCE-2) randomized clinical trial, the benefit with ticagrelor and aspirin was predominately present in the first week and persisted throughout the 21-day period of dual antiplatelet therapy with ticagrelor and aspirin in patients with a minor stroke or TIA who carried CYP2C19 LOF alleles.

Meaning  The findings suggest that the benefit with ticagrelor and aspirin found in CHANCE-2 among patients with a minor ischemic stroke or TIA carrying CYP2C19 LOF alleles was predominant in the first week, with a small benefit observed in the following 2 weeks.

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