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This multicentre, prospective, randomised, open-label, blinded-endpoint clinical trial conducted in China compared low-dose ticagrelor plus aspirin with clopidogrel plus aspirin for preventing early neurological deterioration in patients with high-risk non-disabling ischemic cerebrovascular events. Patients presenting within 24 hours of symptom onset were randomised to ticagrelor 60 mg twice daily plus aspirin (n=167) or clopidogrel plus aspirin (n=167). The primary endpoint was early neurological deterioration within 7 days, defined as an increase of at least 2 points in the National Institutes of Health Stroke Scale (NIHSS) score or an increase of at least 1 point in the NIHSS motor score. Early neurological deterioration occurred in 10.8% of patients receiving ticagrelor-based therapy versus 22.2% receiving clopidogrel-based therapy (relative risk, 0.55; 95% CI, 0.33–0.92; p=0.023). At 90 days, excellent functional outcome, defined as a modified Rankin Scale score of 0–1, was achieved by 92.8% versus 80.8%, respectively (relative risk, 1.13; 95% CI, 1.05–1.23; p=0.002). Major ischemic vascular events occurred in 6.6% versus 10.8% (p=0.085), without a statistically significant difference. Any bleeding occurred in 6.0% of the ticagrelor group and 4.2% of the clopidogrel group; all reported bleeding events were mild. Overall adverse-event rates were similar. The authors concluded that low-dose ticagrelor plus aspirin reduced early neurological deterioration and improved 90-day functional outcomes without a statistically significant increase in bleeding, suggesting a potential alternative antiplatelet strategy in this population.
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This multicentre, prospective, randomised, open-label, blinded-endpoint clinical trial conducted in China compared low-dose ticagrelor plus aspirin with clopidogrel plus aspirin for preventing early neurological deterioration in patients with high-risk non-disabling ischemic cerebrovascular events. Patients presenting within 24 hours of symptom onset were randomised to ticagrelor 60 mg twice daily plus aspirin (n=167) or clopidogrel plus aspirin (n=167). The primary endpoint was early neurological deterioration within 7 days, defined as an increase of at least 2 points in the National Institutes of Health Stroke Scale (NIHSS) score or an increase of at least 1 point in the NIHSS motor score. Early neurological deterioration occurred in 10.8% of patients receiving ticagrelor-based therapy versus 22.2% receiving clopidogrel-based therapy (relative risk, 0.55; 95% CI, 0.33–0.92; p=0.023). At 90 days, excellent functional outcome, defined as a modified Rankin Scale score of 0–1, was achieved by 92.8% versus 80.8%, respectively (relative risk, 1.13; 95% CI, 1.05–1.23; p=0.002). Major ischemic vascular events occurred in 6.6% versus 10.8% (p=0.085), without a statistically significant difference. Any bleeding occurred in 6.0% of the ticagrelor group and 4.2% of the clopidogrel group; all reported bleeding events were mild. Overall adverse-event rates were similar. The authors concluded that low-dose ticagrelor plus aspirin reduced early neurological deterioration and improved 90-day functional outcomes without a statistically significant increase in bleeding, suggesting a potential alternative antiplatelet strategy in this population.
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