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Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA

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dc.contributor.author Johnston, S Claiborne
dc.contributor.author Amarenco, Pierre
dc.contributor.author Denison, Hans
dc.contributor.author Evans, Scott R
dc.contributor.author Himmelmann, Anders
dc.contributor.author James, Stefan
dc.contributor.author Knutsson, Mikael
dc.contributor.author Ladenvall, Per
dc.contributor.author Molina, Carlos A.
dc.contributor.author Wang, Yongjun
dc.contributor.author THALES Investigators
dc.contributor.author Ameriso, Sebastián Francisco
dc.date.accessioned 2021-04-22T13:56:50Z
dc.date.available 2021-04-22T13:56:50Z
dc.date.issued 2020-07-16
dc.identifier.citation Johnston SC, Amarenco P, Denison H, Evans SR, Himmelmann A, James S, Knutsson M, Ladenvall P, Molina CA, Wang Y, THALES Investigators, Ameriso SF. Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N Engl J Med. 2020 Jul 16;383(3):207-217. doi: 10.1056/NEJMoa1916870. es_ES
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/429
dc.identifier.uri https://www.nejm.org/doi/pdf/10.1056/NEJMoa1916870
dc.description.abstract Background: Trials 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. Methods: We 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. Results: A 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). Conclusions: Among 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. (Funded by AstraZeneca; THALES ClinicalTrial.gov number, NCT03354429.). es_ES
dc.language.iso eng es_ES
dc.publisher Massachusetts Medical Society es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Ischemic Stroke es_ES
dc.subject Accidente Cerebrovascular es_ES
dc.subject Stroke es_ES
dc.subject Aspirin es_ES
dc.subject Aspirina es_ES
dc.subject Ticagrelor es_ES
dc.title Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Ameriso, Sebastián Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.
dc.description.fil Fil: Johnston, S Claiborne. University of Texas at Austin. Dell Medical School. Dean's Office; Estados Unidos.
dc.description.fil Fil: Amarenco, Pierre. University of Paris. Bichat-Claude Bernard Hospital. Department of Neurology and Stroke Center; Francia.
dc.description.fil Fil: Denison, Hans. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.
dc.description.fil Fil: Himmelmann, Anders. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.
dc.description.fil Fil: Knutsson, Mikael. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.
dc.description.fil Fil: Ladenvall, Per. AstraZeneca. Biopharmaceuticals Research and Development; Suecia.
dc.description.fil Fil: James, Stefan. Uppsala University. Department of Medical Sciences; Suecia.
dc.description.fil Fil: Evans, Scott R. George Washington University. the Biostatistics Center; Estados Unidos.
dc.description.fil Fil: Molina, Carlos A. Vall d'Hebron Hospital. The Stroke Unit; España.
dc.description.fil Fil: Wang, Yongjun. Capital Medical University. Tiantan Hospital. Department of Neurology; China.
dc.relation.ispartofVOLUME 383
dc.relation.ispartofNUMBER 3
dc.relation.ispartofPAGINATION 207-217
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Boston
dc.relation.ispartofTITLE The New England journal of medicine
dc.relation.ispartofISSN 1533-4406
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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