Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA

RCT (n=11,016) found composite of stroke or death within 30 days was lower with ticagrelor–aspirin vs. aspirin alone (5.5. vs. 6.6%;HR 0.83; 95% CI, 0.71-0.96; p=0.02) but incidence of disability did not differ significantly and severe bleeding was more frequent with ticagrelor.

SPS commentary:

An editorial discusses whether clinicians should now choose ticagrelor or clopidogrel if they want to add a second antiplatelet drug to aspirin. It notes that data from an ongoing direct comparison of these dual antiplatelet strategies in patients with TIA or minor stroke (Clopidogrel with Aspirin in High-risk Patients with Acute Non-disabling Cerebrovascular Events II [CHANCE-2]; are pending. It suggests that the bleeding risk associated with ticagrelor and aspirin might exceed the benefit among lower-risk patients who make up the majority in practice, and so the current trial results should not be overgeneralised. It adds that regardless of which combination of antiplatelet drugs is favoured for the high-risk minority, all patients should receive aspirin immediately after TIA unless aspirin is contraindicated, as too many patients are sent home from emergency departments without this simple treatment that substantially reduces the risk and severity of early recurrent stroke.


New England Journal of Medicine

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