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Time Course for Ben...
Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack
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- Wang, Yongjun (author)
- Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China.;Capital Med Univ, China Natl Clin Res Ctr Neurol Dis, Dept Neurol, Beijing, Peoples R China.
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- Pan, Yuesong (author)
- Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China.;Capital Med Univ, China Natl Clin Res Ctr Neurol Dis, Dept Neurol, Beijing, Peoples R China.
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- Li, Hao (author)
- Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China.;Capital Med Univ, China Natl Clin Res Ctr Neurol Dis, Dept Neurol, Beijing, Peoples R China.
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- Amarenco, Pierre (author)
- Univ Paris, Bichat Claude Bernard Hosp, Dept Neurol, Paris, France.;Univ Paris, Bichat Claude Bernard Hosp, Stroke Ctr, 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)
- Vall dHebron Hosp, Stroke Unit, Barcelona, Spain.
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- Johnston, S. Claiborne (author)
- Univ Texas Austin, Dell Med Sch, Austin, TX USA.
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Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China;Capital Med Univ, China Natl Clin Res Ctr Neurol Dis, Dept Neurol, Beijing, Peoples R China. Univ Paris, Bichat Claude Bernard Hosp, Dept Neurol, Paris, France.;Univ Paris, Bichat Claude Bernard Hosp, Stroke Ctr, Paris, France. (creator_code:org_t)
- Wolters Kluwer, 2022
- 2022
- English.
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In: Neurology. - : Wolters Kluwer. - 0028-3878 .- 1526-632X. ; 99:1, s. E46-E54
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Abstract
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- 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 approximate to 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
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- ref (subject category)
- art (subject category)
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Neurology
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- By the author/editor
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Wang, Yongjun
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Pan, Yuesong
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Li, Hao
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Amarenco, Pierre
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Denison, Hans
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Evans, Scott R.
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show more...
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Himmelmann, Ande ...
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James, Stefan, 1 ...
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Knutsson, Mikael
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Ladenvall, Per
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Molina, Carlos A ...
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Johnston, S. Cla ...
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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 Neurology
- Articles in the publication
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Neurology
- By the university
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Uppsala University