Ticagrelor plus aspirin lowers risk of recurrent stroke, death vs aspirin alone

In this randomized, placebo-controlled, double-blind trial, 11,016 patients with a prior mild-to-moderate acute noncardioembolic ischemic stroke, with a National Institutes of Health Stroke Scale (NIHSS) score of <5 or transient ischemic attack (TIA).and who were not undergoing thrombolysis or thrombectomy, were randomized to receive a 30-day regimen of ticagrelor plus aspirin (n = 5523) or aspirin (n = 5493) within 24 hours of the start of symptoms.

Stroke or death occurred in 5.5% of patients taking ticagrelor in combination with aspirin compared with 6.6% of patients taking aspirin alone (HR = 0.83; 95% CI, 0.71-0.96, P = 0.02).

Ischemic stroke occurred in 5.0% of patients taking ticagrelor in combination with aspirin compared with 6.3% of patients taking aspirin alone (HR = 0.79; 95% CI, 0.68 to 0.93; P = 0.004).

The incidence of disability was not significantly different between the groups.

Severe bleeding occurred in 0.5% and 0.1% of patients in the ticagrelor plus aspirin group and the aspirin group, respectively.

Reference

Johnston SC, Amarenco P, Denison H, et al. Ticagrelor and aspirin or aspirin alone in acute aschemic stroke or TIA. N Engl J Med. 2020; 383:207-217. DOI: 10.1056/NEJMoa1916870