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Randomized Controlled Trial
. 2024 May;38(5):387-398.
doi: 10.1007/s40263-024-01080-5. Epub 2024 Apr 15.

Ticagrelor Versus Clopidogrel in Acute Large-Vessel Ischemic Stroke: A Randomized Controlled Single-Blinded Trial

Mohamed G Zeinhom  1 , Ahmed Elbassiouny  2 , Ahmed Mahmoud Mohamed  3 , Sherihan Rezk Ahmed  4
Affiliations
Randomized Controlled Trial

Ticagrelor Versus Clopidogrel in Acute Large-Vessel Ischemic Stroke: A Randomized Controlled Single-Blinded Trial

Mohamed G Zeinhom et al. CNS Drugs. 2024 May.

Abstract

Background: 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.

Objectives: We aimed to compare ticagrelor versus clopidogrel in the first-ever large-vessel occlusion (LVO) acute ischemic stroke in Egypt.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: Clinical trials.gov (NCT06120725).

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Conflict of interest statement

Mohamed G. Zeinhom, Ahmed Elbassiouny, Ahmed Mahmoud Mohamed, and Sherihan Rezk Ahmed declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Cumulative incidence of any stroke at 90 days in all patients
Fig. 3
Fig. 3
Cumulative incidence of drug-related hemorrhagic complications in all patients
Fig. 4
Fig. 4
Favorable outcome (mRS 0–2) after 90 days in all patients
See this image and copyright information in PMC

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