Ticagrelor of Net Clinical Benefit After Stroke, TIA: THALES
New evidence suggesting that the benefit of ticagrelor outweighs the risk when added to aspirin for 30 days after a mild-to-moderate ischemic stroke or high-risk transient ischemic attack (TIA) has been reported from a secondary analysis of the THALES trial.

In patients with acute mild-moderate ischemic stroke or high-risk transient ischemic attack (TIA), the Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial demonstrated that when added to aspirin, ticagrelor reduced stroke or death but increased risk of severe hemorrhage compared with placebo. The primary efficacy outcome of THALES included hemorrhagic stroke and death, events also counted in the primary safety outcome.

In a randomized, placebo-controlled, double-blind trial of patients with mild-to-moderate acute noncardioembolic ischemic stroke or high-risk TIA, patients were randomized within 24 hours after symptom onset to a 30-day regimen of either ticagrelor plus aspirin or matching placebo plus aspirin. For the present analyses, we defined the efficacy outcome, major ischemic events, as the composite of ischemic stroke or non-hemorrhagic death, and defined the safety outcome, major hemorrhage, as intracranial hemorrhage or hemorrhagic death. Net clinical impact was defined as the combination of these two endpoints.

Results:
-- In 11 016 patients (5523 ticagrelor-aspirin and 5493 aspirin), a major ischemic event occurred in 294 patients (5.3%) in the ticagrelor-aspirin group and in 359 patients (6.5%) in the aspirin group.

-- Major hemorrhage occurred in 22 patients (0.4%) in the ticagrelor-aspirin group and 6 patients (0.1%) in the aspirin group.

-- Net clinical impact favored ticagrelor-aspirin.

-- Findings were similar when different thresholds for disability were applied and over a range of predefined subgroups.

Conclusively, in patients with mild-moderate ischemic stroke or high-risk TIA, ischemic benefits of 30-day treatment with ticagrelor-aspirin outweigh risks of hemorrhage.

Source: https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.035555
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