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Ticagrelor and Aspi...
Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
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- Johnston, S. Claiborne (author)
- Univ Texas Austin, Dell Med Sch, Deans Off, 1501 Red River St, Austin, TX 78712 USA.
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- Amarenco, Pierre (author)
- Univ Paris, Dept Neurol, Bichat Claude Bernard Hosp, Paris, France.;Univ Paris, Stroke Ctr, Bichat Claude Bernard Hosp, Paris, France.
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- Denison, Hans (author)
- AstraZeneca, Biopharmaceut Res & Dev, Gothenburg, Sweden.
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- Evans, Scott R. (author)
- George Washington Univ, Biostat Ctr, Washington, DC USA.
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- Himmelmann, Anders (author)
- AstraZeneca, Biopharmaceut Res & Dev, Gothenburg, Sweden.
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- James, Stefan, 1964- (author)
- Uppsala universitet,Kardiologi
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- Knutsson, Mikael (author)
- AstraZeneca, Biopharmaceut Res & Dev, Gothenburg, Sweden.
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- Ladenvall, Per (author)
- AstraZeneca, Biopharmaceut Res & Dev, Gothenburg, Sweden.
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- Molina, Carlos A. (author)
- Vali dHebron Hosp, Stroke Unit, Barcelona, Spain.
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- Wang, Yongjun (author)
- Capital Med Univ, Dept Neurol, Tiantan Hosp, Beijing, Peoples R China.
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THALES investigators, Group author (author)
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Univ Texas Austin, Dell Med Sch, Deans Off, 1501 Red River St, Austin, TX 78712 USA Univ Paris, Dept Neurol, Bichat Claude Bernard Hosp, Paris, France.;Univ Paris, Stroke Ctr, Bichat Claude Bernard Hosp, Paris, France. (creator_code:org_t)
- Massachusetts Medical Society, 2020
- 2020
- English.
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In: New England Journal of Medicine. - : Massachusetts Medical Society. - 0028-4793 .- 1533-4406. ; 383:3, s. 207-217
- Related links:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- BackgroundTrials have evaluated the use of clopidogrel and aspirin to prevent stroke after an ischemic stroke or transient ischemic attack (TIA). In a previous trial, ticagrelor was not better than aspirin in preventing vascular events or death after stroke or TIA. The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied.MethodsWe conducted a randomized, placebo-controlled, double-blind trial involving patients who had had a mild-to-moderate acute noncardioembolic ischemic stroke, with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less (range, 0 to 42, with higher scores indicating more severe stroke), or TIA and who were not undergoing thrombolysis or thrombectomy. The patients were assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive a 30-day regimen of either ticagrelor (180-mg loading dose followed by 90 mg twice daily) plus aspirin (300 to 325 mg on the first day followed by 75 to 100 mg daily) or matching placebo plus aspirin. The primary outcome was a composite of stroke or death within 30 days. Secondary outcomes were first subsequent ischemic stroke and the incidence of disability within 30 days. The primary safety outcome was severe bleeding.ResultsA total of 11,016 patients underwent randomization (5523 in the ticagrelor–aspirin group and 5493 in the aspirin group). A primary-outcome event occurred in 303 patients (5.5%) in the ticagrelor–aspirin group and in 362 patients (6.6%) in the aspirin group (hazard ratio, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.02). Ischemic stroke occurred in 276 patients (5.0%) in the ticagrelor–aspirin group and in 345 patients (6.3%) in the aspirin group (hazard ratio, 0.79; 95% CI, 0.68 to 0.93; P=0.004). The incidence of disability did not differ significantly between the two groups. Severe bleeding occurred in 28 patients (0.5%) in the ticagrelor–aspirin group and in 7 patients (0.1%) in the aspirin group (P=0.001).ConclusionsAmong patients with a mild-to-moderate acute noncardioembolic ischemic stroke (NIHSS score ≤5) or TIA who were not undergoing intravenous or endovascular thrombolysis, the risk of the composite of stroke or death within 30 days was lower with ticagrelor–aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups. Severe bleeding was more frequent with ticagrelor.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Allmänmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- General Practice (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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- ref (subject category)
- art (subject category)
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Johnston, S. Cla ...
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Amarenco, Pierre
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Denison, Hans
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Evans, Scott R.
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Himmelmann, Ande ...
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James, Stefan, 1 ...
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show more...
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Knutsson, Mikael
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Ladenvall, Per
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Molina, Carlos A ...
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Wang, Yongjun
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THALES investiga ...
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and General Practice
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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New England Jour ...
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Uppsala University