- Question
- Does a 30-day combination of ticagrelor and aspirin prevent stroke and death better than aspirin alone in patients with mild-to-moderate acute ischemic stroke or TIA?
- Design
- Randomized, double-blind, placebo-controlled, international multicenter phase III trial of 11016 patients assigned 1:1 within 24 hours of symptom onset. The primary follow-up was 30 days.
- Population
- Patients with mild-to-moderate acute noncardioembolic ischemic stroke (NIHSS score of 5 or less) or TIA who were not undergoing thrombolysis or thrombectomy.
- Intervention
- Ticagrelor (180-mg loading dose, then 90 mg twice daily) plus aspirin (300 to 325 mg on the first day, then 75 to 100 mg daily) for 30 days.
- Control
- Matching placebo plus aspirin on the same regimen for 30 days.
- Primary outcome
- Composite of stroke or death within 30 days.
- Results
- A primary-outcome event occurred in 303 patients (5.5%) with ticagrelor-aspirin and 362 (6.6%) with aspirin alone (HR 0.83; 95% CI 0.71 to 0.96; P = 0.02). Ischemic stroke occurred in 276 patients (5.0%) versus 345 (6.3%) (HR 0.79; 95% CI 0.68 to 0.93; P = 0.004).
- Safety
- Severe bleeding was more frequent with ticagrelor-aspirin (28 patients, 0.5%) than with aspirin (7 patients, 0.1%) (P = 0.001).
- Conclusion
- In mild-to-moderate ischemic stroke or TIA, ticagrelor plus aspirin lowered the composite of stroke or death at 30 days compared with aspirin alone, with no significant difference in disability and more severe bleeding.
- Why it matters
- It showed that short-term dual antiplatelet therapy with ticagrelor is a feasible strategy for early secondary prevention after a minor cerebrovascular event, and that the ischemic benefit must be weighed against the higher bleeding risk.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 15, 2026