Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
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Le résumé fourni par la source
BACKGROUND: 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. METHODS: We conducted a randomized, placebo-controlled, double-blind trial involving patients who had had a mild-to-moderate acute noncardioembolic ischemic stroke, with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less (range, 0 to 42, with higher scores indicating more severe stroke), 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 (180-mg loading dose followed by 90 mg twice daily) plus aspirin (300 to 325 mg on the first day followed by 75 to 100 mg daily) or matching placebo plus aspirin. The primary outcome was a composite of stroke or death within 30 days. Secondary outcomes were first subsequent ischemic stroke and the incidence of disability within 30 days. The primary safety outcome was severe bleeding. RESULTS: 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 (5.5%) in the ticagrelor-aspirin group and in 362 patients (6.6%) in the aspirin group (hazard ratio, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P = 0.02). Ischemic stroke occurred in 276 patients (5.0%) in the ticagrelor-aspirin group and in 345 patients (6.3%) in the aspirin group (hazard ratio, 0.79; 95% CI, 0.68 to 0.93; P = 0.004). The incidence of disability did not differ significantly between the two groups. Severe bleeding occurred in 28 patients (0.5%) in the ticagrelor-aspirin group and in 7 patients (0.1%) in the aspirin group (P = 0.001). CONCLUSIONS: Among patients with a mild-to-moderate acute noncardioembolic ischemic stroke (NIHSS score ≤5) 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. (Funded by AstraZeneca; THALES ClinicalTrial.gov number, NCT03354429.).
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
- Date Crossref
- 16/07/2020
- Éditeur
- Massachusetts Medical Society
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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The University of Texas at Austin Dell Medical School pays non établi dans la noticeUniversité ou école supérieure
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Université Paris Cité pays non établi dans la noticeUniversité ou école supérieure
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Hôpital Bichat-Claude-Bernard pays non établi dans la noticeÉtablissement de santé
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AstraZeneca (Italy) pays non établi dans la noticeEntreprise
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George Washington University Biostatistics Center pays non établi dans la noticeUniversité ou école supérieure
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Uppsala University Department of Medical Sciences pays non établi dans la noticeUniversité ou école supérieure
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Vall d'Hebron Hospital Universitari Stroke Unit pays non établi dans la noticeÉtablissement de santé
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Capital Medical University Department of Neurology pays non établi dans la noticeUniversité ou école supérieure
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Beijing Tian Tan Hospital pays non établi dans la noticeÉtablissement de santé
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University of Paris Department of Neurology and Stroke Center pays non établi dans la noticeUniversité ou école supérieure
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Biopharmaceuticals Research and Development pays non établi dans la noticeInstitution
Dell Medical School — The University of Texas at Austin, Université Paris Cité et Hôpital Bichat-Claude-Bernard, avec 8 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.