Ticagrelor + ASA in AIS/TIA

TWO CAN MAKE IT – LESS LIKELY TO HAVE ANOTHER STROKE 

BUT MORE LIKELY TO HAVE A BLEED (THALES TRIAL)

SGEM#303 - By admin - October 03, 2020 

Reference: Claiborne Johnston S et al. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. NEJM July 2020

"CLINICAL QUESTION: IS THE COMBINATION OF TICAGRELOR AND ASPIRIN SUPERIOR TO ASPIRIN ALONE IN REDUCING THE RISK OF SUBSEQUENT STROKE OR DEATH AMONG PATIENTS WITH ACUTE NON-CARDIOEMBOLIC CEREBRAL ISCHEMIA?

LESS STROKES AND MORE BLEEDS IN THE COMBINATION GROUP WITH NO STATISTICAL DIFFERENCE BETWEEN THE TWO GROUPS FOR A GOOD NEUROLOGIC OUTCOME.

SGEM BOTTOM LINE: TICAGRELOR IN COMBINATION WITH ASPIRIN CANNOT BE ROUTINELY RECOMMENDED AT THIS TIME. THE DECREASE IN SUBSEQUENT STROKES COMES AT A COST OF INCREASED SERIOUS BLEEDING AND NO INCREASE IN A GOOD NEUROLOGIC OUTCOME. A RISK ASSESSMENT AND SHARED DECISION MAKING IS ENCOURAGED."