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The ACT TBM randomized trial evaluated whether adding aspirin or clopidogrel to standard antituberculous treatment could reduce clinical stroke or MRI-detected cerebral infarction in tuberculous meningitis. Two hundred and thirty-seven patients were randomised to aspirin, clopidogrel or standard therapy, with MRI and vascular imaging performed during follow-up. At one and three months, there was no significant difference between groups in clinical stroke, imaging-based infarction, mortality or functional outcome. Major bleeding was uncommon and occurred in two patients overall. The findings are important because earlier smaller studies had suggested that aspirin might reduce vascular complications in TB meningitis. ACT TBM provides larger, contemporary evidence against assuming a routine clinical benefit from adjunctive antiplatelet therapy. For HCPs, standard anti-tuberculous therapy and corticosteroid management remain the foundation of care, while cerebral infarction and vasculopathy require careful neurological and imaging assessment. The study is particularly relevant to IANCON's dedicated neuroinfection programme and its emphasis on tuberculous meningitis and neurological complications.
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The ACT TBM randomized trial evaluated whether adding aspirin or clopidogrel to standard antituberculous treatment could reduce clinical stroke or MRI-detected cerebral infarction in tuberculous meningitis. Two hundred and thirty-seven patients were randomised to aspirin, clopidogrel or standard therapy, with MRI and vascular imaging performed during follow-up. At one and three months, there was no significant difference between groups in clinical stroke, imaging-based infarction, mortality or functional outcome. Major bleeding was uncommon and occurred in two patients overall. The findings are important because earlier smaller studies had suggested that aspirin might reduce vascular complications in TB meningitis. ACT TBM provides larger, contemporary evidence against assuming a routine clinical benefit from adjunctive antiplatelet therapy. For HCPs, standard anti-tuberculous therapy and corticosteroid management remain the foundation of care, while cerebral infarction and vasculopathy require careful neurological and imaging assessment. The study is particularly relevant to IANCON's dedicated neuroinfection programme and its emphasis on tuberculous meningitis and neurological complications.
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