2026-04-18T04:27:02Zhttps://recercat.cat/oai/request

oai:recercat.cat:11351/88632025-10-24T10:35:38Zcom_2072_378070com_2072_378040col_2072_378092

Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack Wang, Yongjun Pan, Yuesong Li, Hao Amarenco, Pierre Denison, Hans Evans, Scott R. Molina Cateriano, Carlos Institut Català de la Salut [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 Vall d'Hebron Barcelona Hospital Campus Isquèmia cerebral - Tractament Plaquetes sanguínies - Agregació Analgèsics DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia Other subheadings::Other subheadings::Other subheadings::/drug therapy CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Hematologic Agents::Platelet Aggregation Inhibitors ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::isquemia cerebral Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::usos terapéuticos::fármacos hematológicos::inhibidores de la agregación plaquetaria Aspirin; Acute Ischemic Stroke, Benefit Aspirina; Accidente cerebrovascular isquémico agudo; Beneficio Aspirina; Accident cerebrovascular isquèmic agut; Benefici 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. This study is supported by AstraZeneca. 2023-01-17T07:38:09Z 2023-01-17T07:38:09Z 2022-07-05 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion 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. 1526-632X https://hdl.handle.net/11351/8863 10.1212/WNL.0000000000200355 35437261 000821237800017 http://hdl.handle.net/11351/8863 eng Neurology;99(1) https://doi.org/10.1212/WNL.0000000000200355 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess application/pdf Lippincott Williams & Wilkins Scientia