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The role of ticagrelor in acute ischaemic stroke and high-risk TIA management

MacIver, Claire and Hughes, Tom 2021. The role of ticagrelor in acute ischaemic stroke and high-risk TIA management. Journal of Neurology 268 (1) , pp. 386-388. 10.1007/s00415-020-10336-1

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Following a transient ischaemic attack (TIA) or cerebral infarction associated with mild disability (NIHSS ≤ 5), the risk of recurrence is high in the subsequent 30 days, highlighting the importance of early interventions. Current regimens support the use of one antiplatelet agent in infarction with severe disability, typically Aspirin (a prostaglandin H synthase in inhibitor) 300 mg daily for 2 weeks, followed by Clopidogrel (which inhibits the binding of adenosine diphosphate to its platelet P2Y12 receptor) 75 mg daily. For patients with high-risk TIAs or cerebral infarction with mild disability (NIHSS score of five or less), dual-antiplatelet therapy for 10–21 days (depending on bleeding risk) with aspirin 75 mg and clopidogrel 75 mg is recommended, followed by clopidogrel 75 mg alone. A disadvantage of clopidogrel is that in a significant minority of patients, activation via hepatic pathways is ineffective, with a corresponding reduction in antiplatelet activity. Ticagrelor (which prevents ADP-mediated P2Y12-dependent platelet activation) is not subject to such variation in metabolism, and has been proposed as an alternative. We have reviewed three papers describing three different comparisons in symptomatic patients with cerebrovascular disease: ticagrelor in patients with and without prior use of aspirin; ticagrelor and aspirin with aspirin; ticagrelor and aspirin with aspirin and clopidogrel. The difference ticagrelor makes does not appear to be dramatic. Overall, the evidence does suggest that we should not yet remove aspirin (bought for pennies from the local pharmacist)—from our rucksacks, glove compartments and kitchen pharmacies.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Springer
ISSN: 0340-5354
Date of First Compliant Deposit: 11 August 2021
Last Modified: 04 May 2023 16:48

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