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Outcomes of Patients Receiving Ticagrelor or Placebo by Baseline National Institutes of Health Stroke Scale (NIHSS) Group
Source publication
Importance
Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and effic...
Contexts in source publication
Context 1
... the rate of the primary efficacy end point was greater in patients with moderate stroke compared with those with less severe stroke (7.6% [ [190 of 3312] in the placebo group) ( Table 2). No significant interaction between treatment assignment and NIHSS group for the pri- ...Context 2
... efficacy end point of stroke or death was identified (Table 2), indicating consistent efficacy of ticagrelor vs placebo among patients with stroke with a baseline NIHSS score of 4 to 5 and 0 to 3. In patients with moderate stroke, the observed primary end point event rate in patients taking ticagrelor was numerically lower than that in patients taking placebo (7.6% vs 9.1%; HR, 0.84; 95% CI, 0.66 to 1.06; risk difference, −1.54%; 95% CI, −3.43 to 0.35), with a number needed to treat of 65 to avoid 1 stroke or death at day 30 (Table 2). This effect size was similar to that in patients with less severe stroke (4.7% vs 5.7%; HR, 0.82; 95% CI, 0.66 to 1.01; risk difference, −1.00%; 95% CI, −2.06 to 0.06), with a number needed to treat of 100. ...Context 3
... efficacy end point of stroke or death was identified (Table 2), indicating consistent efficacy of ticagrelor vs placebo among patients with stroke with a baseline NIHSS score of 4 to 5 and 0 to 3. In patients with moderate stroke, the observed primary end point event rate in patients taking ticagrelor was numerically lower than that in patients taking placebo (7.6% vs 9.1%; HR, 0.84; 95% CI, 0.66 to 1.06; risk difference, −1.54%; 95% CI, −3.43 to 0.35), with a number needed to treat of 65 to avoid 1 stroke or death at day 30 (Table 2). This effect size was similar to that in patients with less severe stroke (4.7% vs 5.7%; HR, 0.82; 95% CI, 0.66 to 1.01; risk difference, −1.00%; 95% CI, −2.06 to 0.06), with a number needed to treat of 100. ...Context 4
... event curves for the primary efficacy end point by treatment assignment and baseline NIHSS group are shown in Figure 2. Ischemic stroke occurred in 121 patients (7.2%) in the ticagrelor group vs 141 patients (8.6%) in the placebo group among those with moderate stroke (HR, 0.83; 95% CI, 0.65 to 1.06), compared with 143 patients (4.3%) in the ticagrelor group vs 182 patients (5.5%) in the placebo group among those with less severe stroke (HR, 0.77; 95% CI, 0.62 to 0.96) (P for interaction = .64; Table 2). Similar findings were observed when the entire population regardless of qualifying event was included (eTable 2 and eFigure 1 in Supplement 2). ...Context 5
... those with stroke with a baseline NIHSS score of 4 to 5, the primary safety end point, GUSTO severe bleeding, occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group (HR, 1.97; 95% CI, 0.59 to 6.53; risk difference, 0.24%; 95% CI, −0.18 to 0.65), with a number needed to harm of 425 to produce 1 severe bleeding within 30 days, while the primary safety end point in those with an NIHSS score of 0 to 3 occurred in 16 patients (0.5%) in the ticagrelor group and 3 patients (0.1%) in the placebo group (risk difference, 0.39%; 95% CI, 0.13 to 0.64), with a number needed to harm of 259 (P for interaction = .26) ( Table 2). In patients with moderate stroke, GUSTO moderate or severe bleeding occurred in 12 patients (0.7%) in the ticagrelor group and in 6 patients (0.4%) in the placebo group (HR, 1.98; 95% CI, 0.74 to 5.28). ...Similar publications
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Aims
This study aims to explore possible associations between self‐efficacy and healthcare and drug expenditures (i.e. direct costs) in patients with chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) in a study investigating the effects of person‐centred care delivered by telephone.
Methods and results
This exploratory an...
Citations
... According to the propensity analysis using IPTW, a lower incidence of major vascular events persisted with DAPT than with SAPT, with an adjusted absolute risk difference of 4.2% and a relative risk of 0.54 (95% CI 0.31 to 0.93; p=0.03). Consistent results were observed in the propensity score-matching model (online supplemental tables [16][17][18]. ...
Objectives
Despite the potential spillover effect, the optimal duration of dual antiplatelet therapy for minor stroke within 72 hours of symptom onset is still uncertain.
Methods
Safety and Efficacy of Aspirin-Clopidogrel in Acute Noncardiogenic Minor Ischemic Stroke (National Institutes of Health Stroke Scale (NIHSS) score≤5) is a prospective cohort study involving patients with minor ischaemic stroke within 72 hours of symptom onset. The DAPT group was further categorised into three subgroups: shorter duration (<10 days), short duration (10–21 days) and long duration (>21 days). The primary efficacy and safety outcomes were composite vascular event and severe bleeding during 90 days.
Results
Among 3061 eligible patients (age was 61.7±12.0 years, 73.3% were men, median (IQR) NIHSS score, 2 (1–3)), 2977 (97.4%) completed the follow-up. Dual antiplatelet therapy (DAPT) and single antiplatelet therapy (SAPT) were administered in 61.0% and 39.0% of patients. Among them, 305 patients (16.8%) received a shorter duration of DAPT, 937 patients (51.7%) received a short duration and 572 patients (31.5%) received a long duration. In the propensity-weighted Cox proportional hazards regression analysis, the use of DAPT in the short-duration group was associated with a lower risk of the primary vascular event outcome (HR (HR)=0.66, 95% CI 0.46 to 0.94, p=0.02) compared with SAPT group. The incidence of severe bleeding events at 90 days was similar. Similar findings were obtained from the propensity score-matching analysis.
Conclusion
Short duration of DAPT (10–21 days) is superior to SAPT in minor stroke within 72 hours, reducing 90-day composite vascular events without increasing bleeding risk.
... To avoid microembolism and recurrent ischemic episodes, dual antiplatelet medication has been shown to be effective in stroke patients. [26][27][28] We hypothesize that enhanced hydration similarly lowers the risk of recurrent ischemic insults by correcting the hypovolemic state of patients with a BUN/Cr ratio of ⩾ 15 and improving microvascular perfusion. This increase in microvascular perfusion is crucial to improving patient outcomes, given that recent MRI perfusion studies have established the presence of END-associated penumbras in lacunar stroke and demonstrated how variations in perfusion due to different microvascular collaterals can affect clinical outcomes. ...
Rationale
Early neurological deterioration (END) within 72 h of stroke onset is associated with poor prognosis. Optimizing hydration might reduce the risk of END.
Aims
This study aimed to determine in acute ischemic stroke patients if enhanced hydration versus standard hydration reduced the incidence of major (primary) and minor (secondary) END, as well as whether it increased the incidence of early neurological improvement (secondary), at 72 h after admission
Sample size estimate
A total of 244 participants per arm.
Methods and design
A prospective, double-blinded, multicenter, parallel-group, randomized controlled trial conducted at four hospitals from April 2014 to July 2020, with data analyzed in August 2020. The sample size estimated was 488 participants (244 per arm). Ischemic stroke patients with measurable neurological deficits of onset within 12 h of emergency department presentation and blood urea nitrogen/creatinine (BUN/Cr) ratio ⩾ 15 at point of admission were enrolled and randomized to 0.9% sodium chloride infusions of varying rates—enhanced hydration (20 mL/kg body weight, one-third given via bolus and remainder over 8 h) versus standard hydration (60 mL/h for 8 h), followed by maintenance infusion of 40–80 mL/h for the subsequent 64 h. The primary outcome measure was the incidence of major END at 72 h after admission, defined as an increase in National Institutes of Health Stroke Scale of ⩾ 4 points from baseline.
Results
Overall, 487 participants were randomized (median age 67 years; 287 females). At 72 h, 7 (2.9%) in the enhanced hydration arm and 5 (2.0%) in the standard hydration developed major END (p = 0.54). The incidence of minor END and early neurological improvement did not differ between treatment arms.
Conclusion and relevance
Enhanced hydration did not reduce END or improve short-term outcomes in acute ischemic stroke.
Trial Registration
ClinicalTrials.gov (NCT02099383, https://clinicaltrials.gov/study/NCT02099383 )
... The incidences of recurrent stroke and composite events outcomes are Kaplan-Meier estimates of the percentage of patients with events at 90 days, whereas the incidence of other outcomes are raw estimates CI confidence interval, MI myocardial infarction, mRS modified Rankin scale, NIHSS National Institute of Health Stroke Scale **Statistically significant at p < 0.05 for primary efficacy outcome and at adjusted p < 0.0125 for secondary efficacy outcomes antiplatelet in moderate and moderate-to-severe ischemic stroke. Although the SAMMPRIS trial concluded that, in TIA and non-disabling ischemic stroke patients with intracranial arterial stenosis, dual antiplatelet therapy with clopidogrel and aspirin was superior to percutaneous transluminal angioplasty and stenting (PTAS) in reducing the risk of early stroke [32], many other trials, such as subgroup analysis of CHANCE, CHARISMA and MATCH trials [7][8][9], did not support combination therapy over single antiplatelet in largevessel stroke; in addition, the median baseline NIHSS of all of our patients was 9-10, and this could cause a different response to dual antiplatelet therapy than the response observed in those with TIA or minor stroke, as our patients had a more severe neurological impairment and larger areas of ischemic injury, which may have a greater risk of a brain hemorrhage [33]. We found no difference between the two groups concerning hemorrhagic and non-hemorrhagic adverse effects. ...
Large-vessel ischemic stroke represents about 25–40% of all ischemic strokes. Few clinical trials compared ticagrelor versus clopidogrel in ischemic stroke patients; all these studies included only patients with a transient ischemic attack or minor stroke; moreover, none of these studies included patients from North Africa.
We aimed to compare ticagrelor versus clopidogrel in the first-ever large-vessel occlusion (LVO) acute ischemic stroke in Egypt.
Our trial involved 580 first-ever LVO ischemic stroke patients who were randomly assigned to administer loading and maintenance doses of ticagrelor or clopidogrel. Screening, randomization, and start of treatment occurred during the first 24 hours of the stroke.
580 patients were included in the intention-to-treat analysis. Thirty patients in the ticagrelor group and 49 patients in the clopidogrel group experienced a new ischemic or hemorrhagic stroke at 90 days (hazard ratio [HR] 0.61; 95% confidence interval [CI] 0.38–0.98; p-value = 0.04), 36 patients in the ticagrelor group, and 57 in the clopidogrel group experienced composite of a new stroke, myocardial infarction, or death due to vascular insults (HR 0.56; 95% CI 0.37–0.87; p = 0.009). Patients who received ticagrelor had better clinical outcomes regarding National Institutes of Health Stroke Scale (NIHSS) reduction and a favorable modified Rankin scale (mRS) score. There were no differences between ticagrelor and clopidogrel regarding hemorrhagic and non-hemorrhagic complications.
Patients with acute large-vessel ischemic stroke who received ticagrelor within the first 24 hours after ischemic stroke had better clinical outcomes based on recurrent stroke rates, NIHSS reduction, and favorable mRS rates compared with those who received clopidogrel. There were no differences between ticagrelor and clopidogrel regarding hemorrhagic and non-hemorrhagic complications.
Clinical trials.gov (NCT06120725).
... The incidences of recurrent stroke and composite events outcomes are Kaplan-Meier estimates of the percentage of patients with events at 90 days, whereas the incidence of other outcomes are raw estimates CI confidence interval, MI myocardial infarction, mRS modified Rankin scale, NIHSS National Institute of Health Stroke Scale **Statistically significant at p < 0.05 for primary efficacy outcome and at adjusted p < 0.0125 for secondary efficacy outcomes antiplatelet in moderate and moderate-to-severe ischemic stroke. Although the SAMMPRIS trial concluded that, in TIA and non-disabling ischemic stroke patients with intracranial arterial stenosis, dual antiplatelet therapy with clopidogrel and aspirin was superior to percutaneous transluminal angioplasty and stenting (PTAS) in reducing the risk of early stroke [32], many other trials, such as subgroup analysis of CHANCE, CHARISMA and MATCH trials [7][8][9], did not support combination therapy over single antiplatelet in largevessel stroke; in addition, the median baseline NIHSS of all of our patients was 9-10, and this could cause a different response to dual antiplatelet therapy than the response observed in those with TIA or minor stroke, as our patients had a more severe neurological impairment and larger areas of ischemic injury, which may have a greater risk of a brain hemorrhage [33]. We found no difference between the two groups concerning hemorrhagic and non-hemorrhagic adverse effects. ...
... A subanalysis of 3312 patients from THALES with moderate AIS (NIHSS [4][5] showed that ticagrelor plus aspirin also nonsignificantly reduced stroke or death versus aspirin in this high-risk group (7.7% vs 9.1%; HR 0.84; 95% CI 0.66 to 1.06; p=0.14). 11 After a priority review based on these data, the US Food and Drug Administration approved dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin for the reduction of stroke in patients with AIS (NIHSS ≤5) or high-risk TIA in November 2020. 12 The most recent (2021) American Heart Association/American Stroke Association, European Stroke Organisation and European Society of Cardiology guidelines now recommend DAPT with ticagrelor and aspirin for the treatment of non-cardioembolic ischaemic stroke (ischaemic stroke NIHSS ≤5 or TIA and ipsilateral stenosis). ...
... Efficacy and safety of DAPT for subsequent stroke prevention in patients with moderate-risk AIS (NIHSS [4][5] or those with ipsilateral stenosis ≥30% are lacking, with limited data from THALES. 11 These patients are associated with high absolute risk of subsequent stroke. The model demonstrated large 1 month and lifetime cost savings in these patients as well with ticagrelor plus aspirin. ...
Objective
THALES demonstrated that ticagrelor plus aspirin reduced the risk of stroke or death but increased bleeding versus aspirin during the 30 days following a mild-to-moderate acute non-cardioembolic ischaemic stroke (AIS) or high-risk transient ischaemic attack (TIA). There are no cost-effectiveness analyses supporting this combination in Europe. To address this, a cost-effectiveness analysis was performed.
Methods
Cost-effectiveness was evaluated using a decision tree and Markov model with a short-term and long-term (30-year) horizon. Stroke, mortality, bleeding and EuroQol-5 Dimension (EQ-5D) data from THALES were used to estimate short-term outcomes. Model transitions were based on stroke severity (disabling stroke was defined as modified Rankin Scale >2). Healthcare resource utilisation and EQ-5D data beyond 30 days were based on SOCRATES, another trial in AIS/TIA that compared ticagrelor with aspirin. Long-term costs, survival and disutilities were based on published literature. Unit costs were derived from national databases and discounted at 3% annually from a Swedish healthcare perspective.
Results
One-month treatment with ticagrelor plus aspirin resulted in 12 fewer strokes, 4 additional major bleeds and cost savings of €95 000 per 1000 patients versus aspirin from a Swedish healthcare perspective. This translated into increased quality-adjusted life-years (0.04) and reduced societal costs (−€1358) per patient over a lifetime horizon. Key drivers of cost-effectiveness were number of patients experiencing subsequent disabling stroke and degree of disability. Findings were robust over a range of input assumptions.
Conclusion
One month of treatment with ticagrelor plus aspirin is likely to improve outcomes and reduce costs versus aspirin in mild-to-moderate AIS or high-risk TIA.
Trial registration number
NCT03354429 .
... 10 . In a secondary analysis of THALES comparing those with NIHSS 0-3 to NIHSS 4-5, there was no difference in the treatment effect with Ticagrelor-Aspirin vs Aspirin alone, and no difference in severe bleeding 11 . Future research may wish to consider whether dual antiplatelet therapy in more severe stroke populations reduces recurrent ischaemic events without causing excessive bleeding. ...
Intensive antiplatelet therapy did not reduce recurrent stroke/transient ischaemic attack (TIA) events as compared with guideline treatment in the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial, but did increase the frequency and severity of bleeding. In this pre-specified analysis, we investigated predictors of bleeding and the association of bleeding with outcome. TARDIS was an international prospective randomised open-label blinded-endpoint trial in participants with ischaemic stroke or TIA within 48 h of onset. Participants were randomised to 30 days of intensive antiplatelet therapy (aspirin, clopidogrel, dipyridamole) or guideline-based therapy (either clopidogrel alone or combined aspirin and dipyridamole). Bleeding was defined using the International Society on Thrombosis and Haemostasis five-level ordered categorical scale: fatal, major, moderate, minor, none. Of 3,096 participants, bleeding severity was: fatal 0.4%, major 1.5%, moderate 1.2%, minor 11.4%, none 85.5%. Major/fatal bleeding was increased with intensive as compared with guideline therapy: 39 vs. 17 participants, adjusted hazard ratio 2.21, 95% CI 1.24–3.93, p = 0.007. Bleeding events diverged between treatment groups in the 8–35 day period but not in the 0–7 or 36–90 day epochs. In multivariate analysis more, and more severe, bleeding events were seen with increasing age, female sex, pre-morbid dependency, increased time to randomisation, prior major bleed, prior antiplatelet therapy and in those randomised to triple vs guideline antiplatelet therapy. More severe bleeding was associated with worse clinical outcomes across multiple physical, emotional and quality of life domains.
Trial registrationISRCTN47823388.
... The neurological function of AIS patients was assessed using the NIHSS score by two neurologists with more than 3 years of work experience. 18 The total score is 0-42 points, of which less than 1 means normal or normal, 1-4 means mild neurological deficit, 5-15 means moderate neurological deficit, and greater than 15 means severe neurological deficit. The average of the two was taken as the final score, and the scores were all completed within 24 h of admission. ...
Purpose
This retrospective observational study was conducted to determine the correlations between serum CXCL9/12 and the severity of acute ischemic stroke (AIS).
Methods
Total 138 patients with AIS were enrolled in the study. These patients underwent Brain CT on admission and blood samples were collected. Serum CXCL9 and CXCL12 were detected by ELISA assay. The correlations of serum CXCL9/12 with AIS was analyzed based on Oxfordshire Community Stroke Project (OCSP) classification, Trial of Org 10,172 in acute stroke treatment (TOAST) classification, National Institutes of Health Stroke Score (NIHSS) score, infarct volume, and modified Rankin scale (mRS) score.
Results
Compared with the controls, patients with AIS had higher levels of serum CXCL9 and CXCL12. Logistic regression analysis determined that CXCL9 and CXCL12 were independent risk factors for AIS. In addition, the increased serum CXCL9 and CXCL12 were associated with TOAST classification, NIHSS score, and infarct volume. However, serum CXCL9 and CXCL12 were not associated with functional outcomes (mRS score). CXCL9 and CXCL12 both exhibited a high diagnostic value in AIS.
Conclusion
Serum CXCL9 and CXCL12 were elevated in patients with AIS, closely correlated with the severity of AIS.
... 20 Haemorrhagic stroke refers to acute neurological dysfunction of the focal or whole brain or spinal cord caused by non-traumatic brain parenchymal, intraventricular and subarachnoid haemorrhage. Ischaemic stroke refers to an acute focal cerebral or retinal infarction excluding other non-ischaemic causes meeting any of the following conditions: (1) with clinical signs or radiological evidence of acute new focal neurological damage exceeding 24 hours in duration, (2) with focal symptoms or signs sustaining shorter than 24 hours, but with radiological evidence of new infarction, (3) the worsening of pre-existing symptoms of vascular origin ischaemic stroke (ie, NIHSS increased ≥4 based on primary ischaemic stroke, excluding the haemorrhagic transformation after infarction or symptomatic intracranial haemorrhage) persisting for more than 24 hours, with or without deterioration of ischaemic lesions on MRI or CT (online supplemental table S3). Secondary efficacy endpoints include a composite vascular event (stroke, myocardial infarction (MI) or vascular death), ischaemic stroke, TIA, MI, vascular death, all-cause death, poor functional outcome (mRS 2-6) and poor quality of life (EuroQoL-5 Dimensions index score ≤0.5) within 90 days, increase in NIHSS score at 7 days, as well as any new stroke (ischaemic or haemorrhagic), all-cause death and poor functional outcome (mRS 2-6) within 1 year. ...
... We make the following primary null hypotheses: in patients with high-risk symptomatic intracranial or extracranial atherosclerosis treated within 72 hours of ictus, there is no difference in the risk of a new stroke within 90 days: (1) between subjects with intensive antiplatelet therapy and those with standard antiplatelet therapy; (2) between subjects with immediate intensive statin therapy and those with delayed intensive statin therapy and (3) between subjects with intensive antiplatelet and immediate intensive statin therapy and those with standard antiplatelet and delayed intensive statin therapy. ...
Background
It remains unclear if intensive antiplatelet and statin treatments begun within 24–72 hours of cerebral ischaemic events from intracranial or extracranial atherosclerosis is effective or safe.
Methods
The Intensive Statin and Antiplatelet Therapy for High-risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial is a randomised, double-blind, placebo-controlled, multicentre and 2×2 factorial trial. 6100 individuals between the ages of 35 and 80 who have experienced a mild ischaemic stroke or high-risk transient ischaemic attack (TIA) within the previous 72 hours that is attributed to ≥50% atherosclerotic stenosis of a major intracranial or extracranial artery or multiple infarctions of atherosclerotic origin will be enrolled in the trial. Eligible subjects will be randomised 1:1:1:1 to one of four groups: (1) intensive antiplatelet therapy (combined clopidogrel and aspirin for days 1–21, then aspirin placebo and clopidogrel for days 22–90) plus immediate intensive statin therapy(atorvastatin at a dose of 80 mg daily for the first 21 days, then 40 mg daily for days 22–90); (2) intensive antiplatelet therapy plus delayed intensive statin therapy (atorvastatin placebo for days 1–3, followed by 40 mg per day of atorvastatin for days 4–90); (3) standard antiplatelet therapy (combination of clopidogrel placebo with aspirin for 90 days) plus immediate intensive statin therapy and (4) standard antiplatelet therapy plus delayed intensive statin therapy. The primary efficacy endpoint is any new stroke (ischaemic or haemorrhagic) within 90 days after randomisation. The primary safety endpoint is moderate to severe bleeding at 90 days.
Conclusion
The INSPIRES trial will assess the efficacy and safety of intensive antiplatelet therapy and immediate intensive statin therapy begun within 72 hours of onset in decreasing the recurrent stroke at 90 days in patients with acute mild ischaemic stroke or high-risk TIA of intracranial or extracranial atherosclerosis origin.
Trial registration number
NCT03635749 .
... In an exploratory analysis, patients with moderate severity stroke (NIHSS score 4-5) receiving DAPT had a lower primary outcome event rate compared to patients assigned to aspirin alone. However, this finding was not significant (HR = 0.84; 95% CI 0.66 to 1.06) [57]. In the CHANCE-2 trial, patients with minor stroke or highrisk TIA carrying CYP2C19 loss-of-function alleles were randomly assigned to ticagrelor plus aspirin or clopidogrel plus aspirin. ...
Purpose of Review
The benefit of using antiplatelet monotherapy in acute ischemic stroke and secondary stroke prevention is well established. In the last few years, several large randomized trials showed that the use of short-term dual antiplatelet therapy in particular stroke subtypes may reduce the risk of recurrent ischemic events. The aim of this article is to provide a critical analysis of the current evidence and recommendations for the use of antiplatelet agents for stroke prevention.
Recent Findings
Long-term therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole is recommended for secondary stroke prevention in patients with noncardioembolic ischemic stroke. Short-term dual antiplatelet therapy with aspirin and clopidogrel is superior to antiplatelet monotherapy in secondary stroke prevention when used in patients with mild noncardioembolic stroke or high-risk transient ischemic attack. Dual therapy, however, is associated with an increased risk of major bleeding, particularly when the treatment is extended for greater than 30 days. Similarly, aspirin plus ticagrelor is superior to aspirin monotherapy for the prevention of recurrent ischemic stroke, although this combination is associated with a higher risk of hemorrhagic complications when compared to other dual antiplatelet regimens. Among patients who carry CYP2C19 genetic polymorphisms associated with a slow bioactivation of clopidogrel, short-term treatment with aspirin plus ticagrelor is superior to aspirin plus clopidogrel for the reduction of recurrent stroke; however, the use of ticagrelor is associated with a higher risk of any bleeding. In patients with symptomatic intracranial stenosis, aggressive medical management in addition to dual antiplatelet therapy up to 90 days is recommended.
Summary
Antiplatelet therapy has an essential role in the management of ischemic stroke. The specific antiplatelet regimen should be individualized based on the stroke characteristics, time from symptom onset, and patient-specific predisposition to develop hemorrhagic complications.
