Introduction: Lacunar stroke, comprising 18% of ischemic stroke, is the second most common subtype of stroke in India. Available data on the effect of dual antiplatelet treatment with aspirin plus clopidogrel versus single antiplatelet therapy with aspirin alone, and their doses in lacunar stroke, are very limited. Our study aimed to investigate the efficacy, safety, and tolerability of dual versus single antiplatelet therapy in patients with a recent occurrence of lacunar stroke.
Methods: This research was a prospective, single-center study conducted at the Department of Neurology. Patients with recent occurrence of lacunar stroke were randomly divided into 4 groups to receive aspirin 150 mg (group 1), aspirin 150 mg plus clopidogrel 75 mg (group 2), aspirin 75 mg plus clopidogrel 75 mg (group 3), and aspirin 75 mg (group 4) once daily. They were then closely monitored for 90 days. 
Results: A total of 360 patients were recruited and followed up for 90 days. The mean age of the patients was 57.8±14.1 years. Also, 188 patients (52.2%) were male. Recurrence of ischemic stroke occurred highest in group 4(22%), with no recurrence in group 2. Comparisons of recurrence of ischemic stroke between group 1 and group 4 (95% CI, 2.6829%, 31.73551%) and between group 3 and group 4 (95% CI, 3.9439%, 32.1542%) were significant (P<0.05). Haemorrhagic events occurred among recipients on dual antiplatelet therapy (DAPT). 
Conclusion: Efficacy-wise, group 2, which received 150 mg of aspirin plus 75 mg of clopidogrel, was found to be superior to the other groups in preventing lacunar stroke. Groups with DAPT manifested a worrisome trend of bleeding events.