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March 26, 2025Frontiers in PharmacologyOpen Access

Ticagrelor-aspirin cuts 90-day recurrent stroke ~23% vs clopidogrel-aspirin in minor stroke or TIA.

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Why the study?

The efficacy and safety of different antiplatelet regimens in minor strokes or transient ischemic attacks remain controversial.

Does ticagrelor or dipyridamole plus aspirin improve efficacy and safety outcomes compared to other antiplatelet regimens in patients with minor stroke or TIA?

Population

61,281 patients with minor strokes or TIAs across 12 studies

Comparison

Different antiplatelet therapies compared via network meta-analysis

Design

Bayesian network meta-analysis of 10 RCTs and 2 Non-RCTs

Key result

Ticagrelor plus aspirin significantly reduced the risk of recurrent stroke at 90 days (OR 0.77) compared to clopidogrel plus aspirin in patients with minor stroke or transient ischemic attack.

Authors

SQShiran QinSGSi GaoDXDandan Xu

Discussion

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Overview

Supports ticagrelor-aspirin over clopidogrel-aspirin for recurrent stroke prevention in minor stroke/TIA; challenges weak consensus while bleeding risk requires evaluation.

Study Design

Type

Meta-Analysis (n=61,281)

Structured PICO

Does ticagrelor or dipyridamole plus aspirin improve efficacy and safety outcomes compared to other antiplatelet regimens in patients with minor stroke or TIA?

P
Population
61,281 patients with minor strokes or transient ischemic attacks (TIAs) pooled from 12 studies (10 RCTs, 2 Non-RCTs). 52.1% male, 47.9% female, ages ranging from 61.5 to 71 years.
I
Intervention
Dual antiplatelet therapies including ticagrelor plus aspirin and dipyridamole plus aspirin
C
Comparator
Other antiplatelet therapies including clopidogrel plus aspirin, cilostazol plus aspirin, aspirin alone, and ticagrelor alone
O
Outcome
Efficacy outcomes: all-cause mortality, excellent outcome, functional independence and recurrent stroke. Safety outcomes: any types of bleeding and intracerebral hemorrhage (ICH).hard clinical

Main Result

Effect estimate: OR 0.77 (95% CI 0.63-0.92)

In patients with minor stroke or TIA, ticagrelor plus aspirin is more effective than clopidogrel plus aspirin for preventing recurrent events but carries a higher bleeding risk.

Limitations

  • Inclusion of both RCTs and Non-RCTs may introduce selection bias
  • Variations across included studies regarding timing of treatment initiation, baseline NIHSS scores, definitions of minor stroke, and anti-platelet dosing protocols
  • Some outcome indicators in the network diagram lacked closed loops, suggesting potential inconsistencies across studies
  • Limited research on Dipyridamole plus Aspirin (only 1 study) making it difficult to draw definitive conclusions
  • Certain outcome subsets included fewer than 10 studies, which may limit the validity of the findings for these outcomes
  • Limited studies for dipyridamole plus aspirin making its superiority difficult to conclude

Cite This Study

Qin et al. (2025) conducted a meta-analysis in Minor stroke or transient ischemic attack (TIA) (n=61,281). Ticagrelor plus Aspirin vs. Clopidogrel plus Aspirin was evaluated on Recurrent stroke at 90 days (OR 0.77, 95% CI 0.63-0.92). Ticagrelor plus aspirin significantly reduced the risk of recurrent stroke at 90 days (OR 0.77) compared to clopidogrel plus aspirin in patients with minor stroke or transient ischemic attack.

synapsesocial.com/papers/6a0d14be4e02b7512ccc9831https://doi.org/10.3389/fphar.2025.1561564
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA2021 · 407 citations
  2. 2Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial2019 · 144 citations
  3. 3Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA2018 · 1,364 citations
  4. 4Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack2013 · 1,875 citations
  5. 5Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial2015 · 204 citations