- Among patients with mild to moderate ischemic stroke or transient ischemic attack (TIA), adding ticagrelor to aspirin reduces risk for recurrent stroke or death with a trade-off of increased severe bleeding.
Why this matters
- Editorial notes other data supporting the combination of aspirin plus clopidogrel and recommends aspirin as a "simple treatment" for all patients after TIA, barring contraindications.
- 30-day risk for recurrent stroke (any type) or death:
- 5.5% with ticagrelor-aspirin vs 6.6% with aspirin alone.
- HR, 0.83 (95% CI, 0.71-0.96).
- Ischemic stroke:
- 5.0% with ticagrelor-aspirin vs 6.3% with aspirin alone.
- HR, 0.79 (95% CI, 0.68-0.93).
- About 24% of patients in both groups became disabled (modified Rankin scale score >1; P=.61).
- Severe bleeding:
- 0.5% with ticagrelor-aspirin vs 0.1% with aspirin alone.
- HR, 3.99 (95% CI, 1.74-9.14).
- International randomized controlled trial with 11,016 patients who had mild to moderate acute noncardioembolic ischemic stroke or TIA not undergoing thrombolysis or thrombectomy.
- Participants were randomly assigned within 24 hours after symptom onset to 30-day regimen of either ticagrelor (180 mg loading dose, then 90 mg twice daily) plus aspirin (300-325 mg on first day, then 75-100 mg daily) or matching placebo plus aspirin.
- Main outcome: composite of stroke or death within 30 days.
- Funding: AstraZeneca.
- Different patient populations, outcome definitions prevent cross-trial comparisons.
- Unknown generalizability.