Evidence map›Paper›PMID 35437261›Full record

ArticleNeurology2022

Time Course for Benefit and Risk of Ticagrelor and Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack.

Yongjun Wang, Yuesong Pan, Hao Li, Pierre Amarenco, Hans Denison, Scott R Evans, Anders Himmelmann, Stefan James, Mikael Knutsson, Per Ladenvall and 2 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 13 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 1 institution in 5 countries.

Yongjun WangFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin. yongjunwang@ncrcnd.org.cn.
Yuesong PanFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.ORCID 0000-0003-3082-6789
Hao LiFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.
Pierre AmarencoFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.ORCID 0000-0002-3842-1236
Hans DenisonFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.ORCID 0000-0003-1961-163X
Scott R EvansFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.
Anders HimmelmannFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.
Stefan JamesFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.ORCID 0000-0003-4413-9736
Mikael KnutssonFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.
Per LadenvallFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.ORCID 0000-0002-0300-8070
Carlos A MolinaFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin.
S Claiborne JohnstonFrom the Department of Neurology (Y.W., Y.P., H.L.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (Y.W., Y.P., H.L.), Beijing; Department of Neurology and Stroke Center (P.A.), Bichat-Claude Bernard Hospital, University of Paris, France; Biopharmaceuticals Research and Development (H.D., A.H., M.K., P.L.), AstraZeneca, Gothenburg, Sweden; Biostatistics Center (S.R.E.), George Washington University, Washington, DC; Department of Medical Sciences (S.J.), Uppsala University, Sweden; Stroke Unit (C.A.M.), Vall d'Hebron Hospital, Barcelona, Spain; and Dean's Office (S.C.J.), Dell Medical School, University of Texas at Austin. yongjunwang@ncrcnd.org.cn.
Université Claude Bernard Lyon 1 · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesThe goal of this work was to investigate the short-term time-course benefit and risk of ticagrelor with aspirin in acute mild-moderate ischemic stroke or high-risk TIA in The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial.

methodsIn an exploratory analysis of the THALES trial, we evaluated the cumulative incidence of irreversible efficacy and safety outcomes at different time points during the 30-day treatment period. The efficacy outcome was major ischemic events defined as a composite of ischemic stroke or nonhemorrhagic death. The safety outcome was major hemorrhage defined as a composite of intracranial hemorrhage and fatal bleedings. Net clinical impact was defined as the combination of these 2 endpoints.

resultsThis analysis included a total of 11,016 patients (5,523 in the ticagrelor-aspirin group, 5,493 in the aspirin group) with a mean age of 65 years, and 39% were women. The reduction of major ischemic events by ticagrelor occurred in the first week (4.1% vs 5.3%; absolute risk reduction 1.15%, 95% CI 0.36%-1.94%) and remained throughout the 30-day treatment period. An increase in major hemorrhage was seen during the first week and remained relatively constant in the following weeks (absolute risk increase ≈0.3%). Cumulative analysis showed that the net clinical impact favored ticagrelor-aspirin in the first week (absolute risk reduction 0.97%, 95% CI, 0.17%-1.77%) and remained constant throughout the 30 days. DISCUSSION: In patients with mild-moderate ischemic stroke or high-risk TIA, the treatment effect of ticagrelor-aspirin was present from the first week. The ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the treatment period, which may support the use of 30-day treatment with ticagrelor and aspirin in these patients. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, for patients with mild-moderate ischemic stroke or high-risk TIA, the ischemic benefit of ticagrelor-aspirin outweighs the risk of major hemorrhage throughout the 30-day treatment period.

Indexed as

Ischemic Attack, TransientIschemic StrokeStrokeAgedAspirinDrug Therapy, CombinationFemaleHemorrhageHumansIschemiaMalePlatelet Aggregation InhibitorsTicagrelorAspirinPlatelet Aggregation InhibitorsTicagrelor

Identifiers

PMID35437261
PMCPMC9259092
OpenAlexW4224212398

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.