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Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial

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Author(s)
Pierre AmarencoGregory W AlbersHans DenisonJ Donald EastonScott R EvansPeter HeldMichael D HillJenny JonassonScott E KasnerPer LadenvallKazuo MinematsuCarlos A MolinaYongjun WangK S Lawrence WongS Claiborne Johnston
Keimyung Author(s)
Sohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
Lancet Neurology
Issued Date
2017
Volume
16
Issue
4
Abstract
Background :Ticagrelor is an effective antiplatelet therapy for patients with coronary atherosclerotic disease and might
be more effective than aspirin in preventing recurrent stroke and cardiovascular events in patients with acute cerebral
ischaemia of atherosclerotic origin. Our aim was to test for a treatment-by-ipsilateral atherosclerotic stenosis
interaction in a subgroup analysis of patients in the Acute Stroke or Transient Ischaemic Attack Treated with Aspirin
or Ticagrelor and Patient Outcomes (SOCRATES) trial.
Methods :SOCRATES was a randomised, double-blind, controlled trial of ticagrelor versus aspirin in patients aged
40 years or older with a non-cardioembolic, non-severe acute ischaemic stroke, or high-risk transient ischaemic attack
from 674 hospitals in 33 countries. We randomly allocated patients (1:1) to ticagrelor (180 mg loading dose on day 1
followed by 90 mg twice daily for days 2–90, given orally) or aspirin (300 mg on day 1 followed by 100 mg daily for
days 2–90, given orally) within 24 h of symptom onset. Investigators classified all patients into atherosclerotic and
non-atherosclerotic groups for the prespecified, exploratory analysis reported in this study. The primary endpoint was
the time to occurrence of stroke, myocardial infarction, or death within 90 days. Efficacy analysis was by intention to
treat. The SOCRATES trial is registered with ClinicalTrials.gov, number NCT01994720.
Findings :Between Jan 7, 2014, and Oct 29, 2015, we randomly allocated 13 199 patients (6589 [50%] to ticagrelor and
6610 [50%] to aspirin). Potentially symptomatic ipsilateral atherosclerotic stenosis was reported in 3081 (23%) of
13 199 patients. We found a treatment-by-atherosclerotic stenosis interaction (p=0·017). 103 (6·7%) of 1542 patients
with ipsilateral stenosis in the ticagrelor group and 147 (9·6%) of 1539 patients with ipsilateral stenosis in the aspirin
group had an occurrence of stroke, myocardial infarction, or death within 90 days (hazard ratio 0·68 [95% CI
0·53–0·88]; p=0·003). In 10 118 patients with no ipsilateral stenosis, 339 (6·7%) of 5047 patients in the ticagrelor
group had an occurrence of stroke, myocardial infarction, or death within 90 days compared with 350 (6·9%) of
5071 in the aspirin group (0·97 [0·84–1·13]; p=0·72). There were no significant differences in the proportion of lifethreatening
bleeding or major or minor bleeding events in patients with ipsilateral stenosis in the ticagrelor group
compared with the aspirin group.
Interpretation :In this prespecified exploratory analysis, ticagrelor was superior to aspirin at preventing stroke,
myocardial infarction, or death at 90 days in patients with acute ischaemic stroke or transient ischaemic attack when
associated with ipsilateral atherosclerotic stenosis. An understanding of stroke mechanisms and causes is important
to deliver safe and efficacious treatments for early stroke prevention.
Keimyung Author(s)(Kor)
손성일
Publisher
School of Medicine
Citation
Pierre Amarenco et al. (2017). Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. Lancet Neurology, 16(4), 301–310. doi: 10.1016/
S1474-4422(17)30038-8
Type
Article
ISSN
1474-4422
Source
https://linkinghub.elsevier.com/retrieve/pii/S1474-4422(17)30038-8
DOI
10.1016/ S1474-4422(17)30038-8
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32819
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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