Ticagrelor is not superior to aspirin in reducing the rate of stroke, myocardial infarction, or death at 90 days, according to a recent double-blind, controlled trial in 674 centers in 33 countries. The international study (the Acute Stroke or Transient Ischaemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes study (SOCRATES)) included 13,199 patients with a nonsevere ischemic stroke or high-risk transient ischemic attack who had not received intravenous or intraarterial thrombolysis, were not considered to have a cardioembolic stroke, and who were randomly assigned 1:1 to receive either ticagrelor or aspirin. The primary end point was the time to occurrence of stroke, myocardial infarction, or death within 90 days. Researchers found:

• Primary end point occurred in 442 of the 6,589 patients (6.7%) treated with ticagrelor vs 497 of the 6,610 patients (7.5%) treated with aspirin (HR, 0.89, non-significant).

• Ischemic stroke occurred in 385 patients (5.8%) treated with ticagrelor vs 441 patients (6.7%) treated with aspirin (HR, 0.87, non-significant).

• Major bleeding occurred in 0.5% of patients treated with ticagrelor vs 0.6% of patients treated with aspirin, intracranial hemorrhage in 0.2% and 0.3%, respectively, and fatal bleeding in 0.1% and 0.1%.

Citation: Johnston SC, Amarenco P, Albers GW, et al. Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med. 2016;375:35-43. doi:10/1056/NEJMoa1603060.