New evidence suggesting that the benefit of ticagrelor outweighs the risk when added to aspirin for 30 days after a mild-to-moderate ischemic stroke or high-risk transient ischemic attack (TIA) has been reported from a secondary analysis of the THALES trial.
The new analysis was presented at the recent European Stroke Organisation Conference (ESOC) and published online in Stroke on September 3.
The main THALES trial, published last year, showed that ticagrelor plus aspirin reduced the risk for stroke or death compared with aspirin alone in patients presenting acutely with stroke or TIA. But the combination also increased the risk for major hemorrhage, leading to some uncertainty on how the results should be translated into clinical practice.
"The trial's main results have been difficult to interpret," said lead investigator Claiborne Johnston, MD, PhD, Dell Medical School, University of Texas, Austin.
"The primary efficacy outcome (stroke or death) included hemorrhagic stroke and hemorrhagic cause of death but these events were also included in the primary safety outcome of severe bleeding so there has been double counting of these events on both sides," he explained.
Another thing that has caused confusion is the emphasis on relative risk, he noted. "There has been a real reduction in ischemic stroke and a real increase in hemorrhagic stroke but if we just look at relative risks, we don't know how to balance the two.
