Ticagrelor-based regimens reduced the risk of recurrent ischemic stroke (OR 0.81) compared to aspirin or clopidogrel, but significantly increased the risk of any bleeding (OR 2.04).
Meta-Analysis (n=32,782)
Yes
Does ticagrelor alone or with aspirin reduce recurrent vascular events in patients with TIA or ischemic stroke compared to aspirin or clopidogrel?
Early initiation of ticagrelor after TIA or ischemic stroke significantly reduces recurrent ischemic events but comes with a substantially higher risk of serious and fatal bleeding.
Effect estimate: OR 0.81 (95% CI 0.74-0.89)
p-value: p=<0.0001
Abstract Background A transient ischemic attack (TIA) or ischemic stroke often signals a high risk of another event, especially in the days following. While aspirin and clopidogrel are standard treatments, their limitations, such as genetic resistance to clopidogrel, have led to interest in ticagrelor as an alternative. We aimed to address this by comparing the efficacy and safety of ticagrelor (either as monotherapy or in combination with aspirin) with those of aspirin or clopidogrel. Methods This systematic review and meta-analysis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Web of Science, and Cochrane databases were comprehensively searched to identify randomized controlled trials comparing ticagrelor alone or with aspirin versus aspirin, clopidogrel, or clopidogrel plus aspirin. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model. Results This study included 32,782 patients with ischemic stroke or TIA. Ticagrelor-based regimens lowered the risk of ischemic stroke (OR = 0.81; 95% CI: 0.75–0.88), with the strongest benefit observed with clopidogrel alone. Composite vascular events were also reduced (OR = 0.78; 95% CI: 0.68–0.89), particularly with ticagrelor plus aspirin. However, ticagrelor increased the risk of bleeding (OR = 2.04; 95% CI: 1.63–2.55), fatal bleeding (OR = 2.22; 95% CI: 1.02–4.79), and hemorrhagic stroke (OR = 1.53; 95% CI: 1.02–2.30). Conclusions Early initiation of ticagrelor after TIA or ischemic stroke can significantly reduce recurrent vascular events, particularly in patients with clopidogrel resistance. However, this benefit comes with a higher risk of serious bleeding, underscoring the importance of careful patient selection and individualized treatment planning.
Almohammed et al. (Wed,) conducted a meta-analysis in Ischemic stroke or TIA (n=32,782). Ticagrelor (alone or with aspirin) vs. Aspirin alone, clopidogrel alone, or clopidogrel plus aspirin was evaluated on Ischemic stroke recurrence (OR 0.81, 95% CI 0.74-0.89, p=<0.0001). Ticagrelor-based regimens reduced the risk of recurrent ischemic stroke (OR 0.81) compared to aspirin or clopidogrel, but significantly increased the risk of any bleeding (OR 2.04).