Ticagrelor vs Aspirin: Which is Best for Secondary Stroke Prevention?
Ticagrelor, a common antiplatelet therapy, is not more effective than aspirin in preventing cardiovascular events 90 days after a patient has had an initial stroke, according to a new study.
After an initial stroke or transient ischemic attack (TIA), patients are at a higher risk for subsequent cerebrovascular events. Aspirin is commonly prescribed as a prevention agent, but the benefit of aspirin in secondary prevention is limited and may raise the risk of hemorrhagic events.
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To compare the effects of aspirin with ticagrelor, the researchers used data from the SOCRATES (Acute Stroke or Transient Ischaemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes) trial, which enrolled patients from 674 sites in 33 countries from January 7, 2014, through October 29, 2015.
Of the 13,199 patients who had had a nonsevere ischemic stroke or high-risk TIA, 6589 were randomly assigned to take ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) and 6610 took aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90).
After 90 days of treatment, 6.7% of patients taking ticagrelor and 7.5% of patients taking aspirin had a stroke, had a heart attack, or died. In addition, 5.8% of those taking ticagrelor and 6.7% of those taking aspirin had an ischemic stroke.
“In our trial involving patients with acute ischemic stroke or transient ischemic attack, ticagrelor was not found to be superior to aspirin in reducing the rate of stroke, myocardial infarction, or death at 90 days,” the researchers concluded.
—Amanda Balbi
Reference:
Johnston SC, Amarenco P, Albers GW, et al; SOCRATES Steering Committee and Investigators. Ticagrelor versus aspirin in acute stroke or transient ischemic attack [published online May 10, 2016]. N Engl J Med. doi:10.1056/NEJMoa1603060.