Ticagrelor versus Aspirin in Ischemic stroke

Abstract

Stroke is the leading cause of sustained disability in the world today. There is an increasing need for new antiplatelet with better efficacy in the management of ischemic stroke patients to ensure better prognosis for many patients who are not eligible for the only FDA-approved thrombolytic therapy rTPA. In our trial registered under number (NCT03884530), 169 patients who came to Kafrelsheikh university hospitals with first ever acute ischemic stroke and did not receive thrombolytic therapy, were randomized within 9 hours of symptoms onset to receive either 180 ml of ticagrelor for 90 days or 300 ml aspirin for 2 weeks then75 ml aspirin for 10 weeks. We compared between the two groups regarding two end points , the primary one which was the safety of the treatment represented by frequency of hemorrhagic and non-hemorrhagic complication in each group and the secondary end point which was the clinical outcome of the two groups assessed with MRs after 1 week and 3 months, NIHSS after 1week, NIHSS difference between first and seventh day of admission, and the duration of hospital stay in each group. In conclusion, loading acute ischemic stroke patients within 9 hours of symptoms with ticagrelor was found to be as safe as aspirin regarding hemorrhagic and non-hemorrhagic complications and, ticagrelor is superior to aspirin in achieving better clinical outcomes. Anterior circulation and large vessel strokes respond to ticagrelor in a way better than their response to aspirin and the shorter the time to receive the treatment the better clinical outcome in means of less hospital stay and lower values of MRs after 3 months and NIHSS after one week. Our study had ClinicalTrials.gov number, (NCT03884530). Recommendations