dc.contributor
Institut Català de la Salut
dc.contributor
[Wang Y, Pan Y, Li H] Beijing Tiantan Hospital, Capital Medical University, China. [Amarenco P] Bichat-Claude Bernard Hospital, University of Paris, France. [Denison H] Biopharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden. [Evans SR] George Washington University, Washington, DC. [Molina CA] Vall d’Hebron Hospital Universitari, Barcelona, Spain
dc.contributor
Vall d'Hebron Barcelona Hospital Campus
dc.contributor.author
Wang, Yongjun
dc.contributor.author
Pan, Yuesong
dc.contributor.author
Li, Hao
dc.contributor.author
Amarenco, Pierre
dc.contributor.author
Denison, Hans
dc.contributor.author
Evans, Scott R.
dc.contributor.author
Molina Cateriano, Carlos
dc.date.accessioned
2025-10-24T10:35:38Z
dc.date.available
2025-10-24T10:35:38Z
dc.date.issued
2023-01-17T07:38:09Z
dc.date.issued
2023-01-17T07:38:09Z
dc.date.issued
2022-07-05
dc.identifier
Wang Y, Pan Y, Li H, Amarenco P, Denison H, Evans SR, et al. Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack. Neurology. 2022 Jul 5;99(1):e46-e54.
dc.identifier
https://hdl.handle.net/11351/8863
dc.identifier
10.1212/WNL.0000000000200355
dc.identifier
000821237800017
dc.identifier.uri
https://hdl.handle.net/11351/8863
dc.description.abstract
Aspirin; Acute Ischemic Stroke, Benefit
dc.description.abstract
Aspirina; Accidente cerebrovascular isquémico agudo; Beneficio
dc.description.abstract
Aspirina; Accident cerebrovascular isquèmic agut; Benefici
dc.description.abstract
Background and objectives: The goal of this work was to investigate the short-term time-course benefit and risk of ticagrelor with aspirin in acute mild-moderate ischemic stroke or high-risk TIA in The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial.
Methods: In an exploratory analysis of the THALES trial, we evaluated the cumulative incidence of irreversible efficacy and safety outcomes at different time points during the 30-day treatment period. The efficacy outcome was major ischemic events defined as a composite of ischemic stroke or nonhemorrhagic death. The safety outcome was major hemorrhage defined as a composite of intracranial hemorrhage and fatal bleedings. Net clinical impact was defined as the combination of these 2 endpoints.
Results: This analysis included a total of 11,016 patients (5,523 in the ticagrelor-aspirin group, 5,493 in the aspirin group) with a mean age of 65 years, and 39% were women. The reduction of major ischemic events by ticagrelor occurred in the first week (4.1% vs 5.3%; absolute risk reduction 1.15%, 95% CI 0.36%-1.94%) and remained throughout the 30-day treatment period. An increase in major hemorrhage was seen during the first week and remained relatively constant in the following weeks (absolute risk increase ≈0.3%). Cumulative analysis showed that the net clinical impact favored ticagrelor-aspirin in the first week (absolute risk reduction 0.97%, 95% CI, 0.17%-1.77%) and remained constant throughout the 30 days.
Discussion: In patients with mild-moderate ischemic stroke or high-risk TIA, the treatment effect of ticagrelor-aspirin was present from the first week. The ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the treatment period, which may support the use of 30-day treatment with ticagrelor and aspirin in these patients.
Classification of evidence: This study provides Class II evidence that, for patients with mild-moderate ischemic stroke or high-risk TIA, the ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the 30-day treatment period.
dc.description.abstract
This study is supported by AstraZeneca.
dc.format
application/pdf
dc.publisher
Lippincott Williams & Wilkins
dc.relation
Neurology;99(1)
dc.relation
https://doi.org/10.1212/WNL.0000000000200355
dc.rights
Attribution-NonCommercial-NoDerivatives 4.0 International
dc.rights
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights
info:eu-repo/semantics/openAccess
dc.subject
Isquèmia cerebral - Tractament
dc.subject
Plaquetes sanguínies - Agregació
dc.subject
DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia
dc.subject
Other subheadings::Other subheadings::Other subheadings::/drug therapy
dc.subject
CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Platelet Aggregation Inhibitors
dc.subject
ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::isquemia cerebral
dc.subject
Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
dc.subject
COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::inhibidores de la agregación plaquetaria
dc.title
Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack
dc.type
info:eu-repo/semantics/article
dc.type
info:eu-repo/semantics/publishedVersion
