Ticagrelor plus aspirin reduces 30-day recurrent stroke, dea
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Trials have evaluated the use of clopidogrel and aspirin to prevent stroke after an ischemic stroke or transient ischemic attack (TIA). In a previous trial, ticagrelor was not better than aspirin in preventing vascular events or death after stroke or TIA. The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied.

Researchers conducted a randomized, placebo-controlled, double-blind trial involving patients who had had a mild-to-moderate acute noncardioembolic ischemic stroke, with a NIHSS score of 5 or less, or TIA and who were not undergoing thrombolysis or thrombectomy. The patients were assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive a 30-day regimen of either ticagrelor plus aspirin or matching placebo plus aspirin.

Resutls:
-- A total of 11,016 patients underwent randomization (5523 in the ticagrelor–aspirin group and 5493 in the aspirin group).
-- A primary-outcome event occurred in 303 patients in the ticagrelor–aspirin group and in 362 patients in the aspirin group.
-- Ischemic stroke occurred in 276 patients in the ticagrelor–aspirin group and in 345 patients in the aspirin group.
-- The incidence of disability did not differ significantly between the two groups. Severe bleeding occurred in 28 patients in the ticagrelor–aspirin group and in 7 patients in the aspirin group.

Conclusively, Among patients with a mild-to-moderate acute noncardioembolic ischemic stroke or TIA who were not undergoing intravenous or endovascular thrombolysis, the risk of the composite of stroke or death within 30 days was lower with ticagrelor–aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups. Severe bleeding was more frequent with ticagrelor.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1916870
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