Patients who suffered a transient ischemic attack (TIA) or minor ischemic stroke and were treated with the P2Y12 inhibitor ticagrelor plus aspirin within 24 hours of the onset of TIA symptoms were 27% less likely to have a second stroke within 30 days, according to results of the THALES trial presented Nov. 16 during AHA 2020 and simultaneously published in Stroke.

Researchers randomized 11,016 participants with a non-cardioembolic, non-severe ischemic stroke, or high-risk TIA to either ticagrelor (180 mg loading dose/Day 1 and 90 mg twice daily/Day 2-30) or placebo added to aspirin (300-325 mg/Day 1 and 75-100 mg daily/Day 2-30) within 24 hours of symptom onset. The primary endpoint was time to the occurrence of stroke or death within 30 days.

Of the patients enrolled in THALES, 21.3% had ipsilateral atherosclerotic stenosis. In these patients, the 30-day absolute event rate of stroke or death was higher (10.9% on aspirin alone) and absolute risk reduction was greater on ticagrelor added to aspirin (3.0%) than in patients with no ipsilateral atherosclerotic stenosis (5.3% and 0.5%, respectively). These findings were consistent with other studies suggesting that patients with atherosclerotic disease are at greater risk than patients with other stroke subtypes.

"Targeting patients with atherosclerotic stenosis for dual therapy with ticagrelor and aspirin could yield a clinically meaningful relative and absolute risk reduction of stroke and death as compared to aspirin alone," concluded Pierre Amarenco, MD, et al.

Keywords: AHA Annual Scientific Sessions, AHA20, Stroke, Aspirin, Atherosclerosis, Ischemia

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