R.E.B.E.L.EM - September 03, 2020 - By Benjamin M. Gerretsen
Paper: Claiborne Johnston S et al. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. NEJM 2020. PMID 32668111
"Clinical Question: Does the addition of ticagrelor to aspirin for 30 days aid in reducing the risk of subsequent stroke or death among patients with acute non-cardioembolic cerebral ischemia?
Author Conclusion: “Among patients with mild-to-moderate 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.”
Clinical Take Home Point: A benefit was observed with ticagrelor + aspirin with respect to the incidence of the secondary outcome of subsequent ischemic stroke, which was lower than with aspirin alone; however, a benefit was not observed with respect to the incidence of overall disability, and additionally there was increase in severe bleeding and intracranial hemorrhage."