Ticagrelor might be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients admitted for acute cerebral ischemia.
This double-blind, controlled trial randomized 13,199 patients from 33 countries. Subjects presented a non-severe stroke or a high-risk transient ischemic attack (TIA) (not considered as cardioembolic) and had not received intravenous or intraarterial thrombolysis.
Patients received either ticagrelor (a 180 mg loading dose followed by 90 mg twice daily) or aspirin (a 300 mg loading dose followed by 100 mg daily). The primary endpoint was the time to the occurrence of the following:
- Stroke.
- Acute myocardial infarction.
- Death within 90 days.
During the 90 days of treatment, primary endpoint events occurred as follows:
In the ticagrelor group: 6.7%
In the aspirin group: 7.5%
(hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.78 to 1.01; p = 0.07).
Recurrent ischemic strokes occurred as follows:
In the ticagrelor group: 5.8%
In the aspirin group: 6.7%
(HR: 0.87; IC 95%: 0.76 to 1.00).
Major bleeding, intracranial hemorrhage, and fatal bleeding rates were almost identical for both drugs.
Conclusion
In patients with stroke or transient ischemic attack, ticagrelor was not found to be superior to aspirin in reducing the rate of recurrent stroke, acute myocardial infarction, or death within 90 days after the index event.
Original title: Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack.
Reference: S. Claiborne Johnston et al. N Engl J Med 2016;375:35-43.
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