The combination of ticagrelor plus aspirin is superior to aspirin alone in reducing the risk for secondary stroke, transient ischemic attack (TIA), and death, new data show.
However, severe bleeding was more common in the ticagrelor-aspirin group than in the aspirin-only group.
“We found that ticagrelor plus aspirin reduced the risk of stroke or death, compared to aspirin alone in patients presenting acutely with stroke or TIA,” reported lead author S. Claiborne Johnston, MD, PhD, dean and vice president for medical affairs, Dell Medical School, the University of Texas, Austin.
“Lots of patients have stroke in the days to weeks after first presenting with a stroke or TIA,” said Johnston, who is also the Frank and Charmaine Denius Distinguished Dean’s Chair at Dell Medical School.
“Aspirin has been the standard of care but is only partially effective. Clopidogrel plus aspirin is another option that has recently been proven, [but] ticagrelor has attractive properties as an antiplatelet agent and works synergistically with aspirin,” he added.
Ticagrelor is a direct-acting antiplatelet agent that does not depend on metabolic activation and that “reversibly binds” and inhibits the P2Y12 receptor on platelets.
Konark Malhotra, MD, a vascular neurologist at Allegheny Health Network, Pittsburgh, Pennsylvania, noted that ticagrelor is an antiplatelet medication “that adds to the armamentarium of stroke neurologists for the treatment of mild acute ischemic or high-risk TIA patients.”
Malhotra, who was not involved with the study, added that the “combined use of ticagrelor and aspirin is effective in the reduction of ischemic events, however, at the expense of increased risk of bleeding events.”
Reference articles:
https://www.medscape.com/viewarticle/934198?src=soc_tw_200721_mscpedt_news_mdscp_aspirin&faf=1
https://www.nejm.org/doi/full/10.1056/NEJMe2018927?af=R&rss=currentIssue
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