JAMA Sub-Journal: Is ticagrelor combined with "magic drug" aspirin more effective in the treatment of patients with stroke

Dual antiplatelet therapy (DAPT) is a key strategy for early treatment of mild non-myocardial infarction ischemic stroke and transient ischemic attack (TIA)

Dual antiplatelet therapy (DAPT) is a key strategy for early treatment of mild non-myocardial infarction ischemic stroke and transient ischemic attack (TIA)

Current guidelines recommend early and short-term (21 days) combined treatment of clopidogrel and aspirin for patients with high-risk TIA and mild non-cardiac ischemic stroke with an NIHSS score of 3 or less

In the THALES trial, patients with TIA or acute ischemic stroke with NIHSS scores of 5 or less were evaluated by DAPT of ticagrelor and aspirin.

The THALES trial showed that compared with the use of aspirin alone, the use of DAPT can reduce the risk of stroke or death within 30 days, and serious bleeding events will not increase

Given that there have been no randomized trials evaluating the efficacy and safety of DAPT in patients with moderate stroke (NIHSS score of 4 to 5), whether the benefits of DAPT can be extended to patients with severe ischemic stroke with NIHSS score of 4 to 5, Aroused the interest of stroke neurologists

The THALES trial is a randomized trial conducted in 414 hospitals in 28 countries from January 2018 to December 2019

Take ticagrelor (180 mg loading dose on day 1 and 90 mg twice daily on days 2 to 30) or placebo within 24 hours after the onset of symptoms

A total of 3312 patients had a moderate stroke, and 6671 patients had a mild stroke

Among patients with moderate stroke, the main outcome event rate in the ticagrelor group was 7.

Among patients with moderate stroke, the main outcome event rate in the ticagrelor group was 7.

However, among patients with moderate stroke, 8 patients (0.

In this study, compared with less severe ischemic stroke patients, ticagrelor plus aspirin in moderate ischemic stroke patients had the same benefit as aspirin alone

In this study, compared with less severe ischemic stroke patients, ticagrelor plus aspirin in moderate ischemic stroke patients had the same benefit as aspirin alone

references:

Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke: An Exploratory Analysis of the THALES Randomized Clinical Trial.

Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke: An Exploratory Analysis of the THALES Randomized Clinical Trial.
JAMA

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