Ticagrelor Added to Aspirin in Acute Ischemic Stroke or Transient Ischemic Attack in Prevention of Disabling Stroke

作者：Pierre Amarenco, Hans Denison, Scott Evans, Anders Himmelmänn, Stefan James, Mikael Knutsson, Per Ladenvall, Carlos A. Molina, Yongjun Wang, S. Claiborne Johnston, Sebastián F. Ameriso, Leonardo Gonzalez, Pablo Ioli, Lorena Jure, Guillermo Povedano, Guadalupe Bruera, Gustavo Herrera, Juan Jose Martin Artesi, Virginia Pujol Lereis, Conrado J. Estol, Maia Gómez Schneider, Santiago Pigretti, Fernando Lipovestky, María Cristina Zurrú, Stephen C. Davis, Andrew Wong, Tissa Wijeratne, Arman Sabet, Andrew Lee, Vincent Thijs, Robin Lemmens, Laetitia Yperzeele, Geert Vanhooren, Peter Vanacker, Iris Vansteenkiste, Vicky Maqueda, André Peeters, M.C. Hasenbroekx, Wendy Van Daele, Adinda De Pauw, Regilio Oedit, Wouter De Vooght, Philippe Desfontaines, Yves Vandermeeren, Marianna Deway Andrade Dracoulakis, Rodrigo Bazán, Octávio Marques Pontes‐Neto, Daniel Bezerra, Luiz Carlos Porcello Marrone, Pedro André Kowacs, Carla Heloísa Cabral Moro, Paulo Cesar Otero Macelino, Marco Túlio Araújo Pedatella, Еkaterina Titianova, Ivan Staikov, Dimitar Maslarov, Plamen Petkov, Tanya Beleva, Borislav Kralev, Nikolay Sotirov, Dimcho Hristov, Rumeliya Mitkova Ivanova, Margarita Velichkova Mihailova, Ashfaq Shuaib, Andrew M. Demchuk, Michel Beaudry, Anthony R Winder, Sumiti Nayar, Huaguang Zheng, Shuya Li, Xingquan Zhao, Guoqiang Wen, Xueshuang Dong, Guozhong Li, Zhaohui Zhang, Dawei Chen, Dong Wang, Xiaohong Li, Yun‐Cheng Wu, Xu Zhang, Baorong Zhang, Wenke Hong, Xiaogang Li, Lijuan Wang, Li Liu, Xiaolin Xu, Peifu Wang, Weihong Zheng, Jinsheng Zeng, Yukai Wang, Yan Jia, Yongqiu Li, Bo Hu, Wei Shen, Zhi Song, Zhiping Hu, Yunhai Liu, Kaifu Ke, Deqin Geng, Shigang Zhao, Runxiu Zhu, Qiumin Qu, Xiuli Zhao, Qi Wan, Yunhua Yue, Huishan Du, Yijun Zhang, Y. Wang, Dongfang Li, Dongyu Wang, Yongqiang Li, Xufang Xie, Tingmin Yu, Qi Liu, Mingxiu Yang, Xiaoping Pan, Lijun Xu, Deen Xu, Gang Li, Anding Xu, Martin Roubec, Petr Geier, Daniel Václavík, Jiří Neumann, Jana Bednářová, Robert Mikulík, David Hlinovský, Pierre Amarenco, Charlotte Cordonnier, Igor Sibon, Caroline Arquizan, Sonia Alamowitch, Bertrand Lapergue, Jean‐Marc Olivot, Nicolas Raposo, Marie‐Hélène Mahagne, Emmanuel Touzé, G. Rodier, Stéphane Vannier, Yves Samson, Michaël Obadia, Emmanuel Ellie, B. Guillon, Serge Timsit, Yannick Béjot, Valérie Wolff, Didier Smadja, Aude Bagan-Triquenot, Pierre Garnier, Xavier Ducrocq, Peggy Reiner, Thierry Moulin, Frédéric Philippeau, Fernando Pico, Sébastien Richard, Joachim Röther, Jörg Berrouschot, Hassan Soda, Carsten Pohlmann, Christoph Terborg, Darius G. Nabavi, Rainer Dziewas, Martin Köhrmann, Jörg Glahn, Lars Marquardt, Bernd Kallmünzer, Karin Weißenborn, Ka Sing Wong, Yannie Soo, Richard Li, Wing Chi Fong, Siu Hung Li, Raymond Tak Fai Cheung, Kin Keung Yip, Joshua Wai Ming Fok, Michael Yat Pang Fu, Norbert Szegedi, Krisztián Pozsegovits, Attila Valikovics, Gyula Pánczél, Csilla Rózsa, Péter Diószeghy, Attila Csányi, Levente Kerényi, Valéria Nagy, László Szapáry, Dániel Bereczki, Sándor Molnár, Gyula Timár, András Folyovich, Mária Sátori, Ildikó Vastagh, Praveen Kumar S, Rajnish Kumar, Atul Prasad, Vikram Sharma, Alok Verma, Indraneel Basu, Abu Zafar Ansari, Vijaya Pamidimukkala, Raghavendra B.S., Vivek Junewar, Sumit Singh, Advait Prakash Kulkarni, Padma MV Srivastava, K Pramod, Sanjay Ganpat Ramteke, Jaideep Bansal, Kewal Krishan, Hrishikesh Kumar, Priyanka V Kashyap, Ramakrishnan Tcr, Gopal Rao Adrasetty, Amit Yeole, Rahul Baviskar, Giancarlo Agnelli, Danilo Toni, Stefano Ricci, Rossana Tassi, Giuseppe Micieli, Michelangelo Mancuso, Giovanni Orlandi, Alberto Chiti, Marialuisa Delodovici, Federico Carimati, Alessandro De Vito, Francesco Perini, Cinzia Finocchi, Tiziana Tassinari, Massimo Del Sette, Luisa Roveri, Andrea Zini, Guido Bigliardi, Francesca Romana Pezzella, Letizia Maria Cupini, Alessandro Adami, Giampaolo Tomelleri, Carla Zanferrari, Angel Antonio Arauz Góngora, Minerva López Ruíz, Angelica Ruíz Franco, José Omar Javier Chacon Romero, Fernando Cruz Castillo, José Luis Ruíz‐Sandoval, Jesús Daniel López Tapia, Edgar Alejandro Castillo Vargas, Fernando Góngora‐Rivera, Guillermo Rivera Martinez, Jorge Villarreal Careaga, Nilton Custodio, Oscar G. Pamo Reyna, Cesar A Castañeda, E. Javier Pretell, Nestor Najar, J. C. Pérez, Luisa Cardoza, Carlos M. Chavez, Maria Reyes, Anna Członkowska, Waldemar Fryze, Piotr Sobolewski, Ryszard Nowak, Dorota Szkopek, Zbigniew Bąk, Sławomir Brzozowski, Waldemar Brola, Marek Zalisz, Konrad Rejdak, Marta Bilik, Małgorzata Fudala, Andrzej Tutaj, Anetta Lasek‐Bal, Jan Kochanowicz, Bartosz Karaszewski, Tomasz Berkowicz, Jacek Zwiernik, Dorota Różański, Jan P. Mejnartowicz, Szymon Jurga, J Rózniecki, Maciej Świat, Ovidiu Băjenaru, Cristina Panea, Mihaela Simu, Rodica Bălașa, Dan Iulian Cuciureanu, Bogdan Popescu, M Sabău, Corina Roman-Filip, Liudmila Odnopozova, Oleg Artyukov, A. S. Milto, Liudmila Vitalievna Stakhovskaya, Sergei Aksentiev, Svetlana E Chuprina, E B Kuznetsova, И. И. Шоломов, A. Yu. Malygin, Elena Mordvintseva, Rostislav Nilk, Inna Ershova, Д. Р. Хасанова, Л.Р. Ахмадеева, Aida Iakupova, E. Drozdova, M. М. Tanashyan, Evgenij Pudov, Lybov A Shpagina, С. А. Бернс, Liudmila G. Lenskaya, K. V. Golikov, Andrey V Kovalenko, Elena Vasilieva, Е. В. Резник, М. В. Зыков, Evgeniy Kovalchuk, Dmitry Popov, А. А. Белкин, O V Androfagina, Tatyana Lokshtanova, Е. В. Мельникова, Fahmi Al-Senani, Nouf Almansour, Fawaz Alhussein, Ali M. Al-Khathaami, Saeed M. Alghamdi, M Brozman, Marta Mikloskova, Georgi Krastev, Vlastimil Serdahely, Michal Kováčik, Ladislav Gurcik, Miloslav Dvorak, Egon Kurča, Andrea Cimprichová, Marian Kycina, Erika Zacharova, Richard Risnovsky, Hee‐Joon Bae, Kyung Bok Lee, Yong‐Jin Cho, Jong‐Moo Park, Joon‐Tae Kim, Jun Lee, Jae‐Kwan Cha, Sung‐Il Sohn, Dong‐Ick Shin, Soo Joo Lee, Byung-Chul Lee, Jay Chol Choi, Moo Seok Park, Dae‐Il Chang, Joung‐Ho Rha, Sang Min Sung, Yang‐Ha Hwang, Carlos Molina Cateriano, Jaume Roquer González, Jaime Masjuán, Meritxell Gomis Cortina, Francisco Moniche Álvarez, Miguel Ángel Gamero García, Soledad Pérez Sánchez, Francisco Purroy, Santiago Trillo Senín, Tomás Segura Martín, Joaquín Serena Leal, Juan Arenillas Lara, Joan Martí‐Fábregas, Aida Lago Martín, C. Tejero Juste, J. Marta Moreno, Nicolás López Hernández, Lars Sjöblom, Ann Charlotte Laska, Margarita Callander, Thomas Mooe, Jan‐Erik Karlsson, Mihaela Oana Romanitan, Arne Lindgren, Niaz Ahmed, Björn Cederin, Christine Kremer, Tsong‐Hai Lee, Jiann‐Shing Jeng, Chih‐Hung Chen, Helen L. Po, Chia‐Wei Liou, Huey‐Juan Lin, Ruey‐Tay Lin, Hsiu‐Fen Lin, Li‐Ming Lien, Lung Chan, Wei-Shih Huang, Wen‐Yi Huang, Ta-Cheng Chen, Chin-I Chen, Po‐Lin Chen, Chun‐Pai Yang, Yu Sun, Aurauma Chutinet, Tasanee Tantirittisak, Sombat Muengtaweepongsa, Yongchai Nilanont, Somsak Tiamkao, Chesda Udommongkol, Witoon Jantararotai, Tabtim Chongsuvivatwong, Suwat Srisuwananukorn, Wasutha Khaykhaew, Supachai Paiboonpol, Makorn Limudomporn, Saengduan Mayotarn, Kanoksri Samintharapanya, Arkhom Arayawichanon, Thanoot Thamangraksat, Duangpol Srimanee, Galyna Chmyr, Nataliya Tomakh, Alla Cherkez, Sergii Moskovko, V.V. Nіkonov, Svitlana Shkrobot, Л. В. Шульга, Hanna Hrebeniuk, Valentyna Yavorska, Nataliia Lytvynenko, Marta Khavunka, Iryna Kobets, Nataliia Chemer, Ivanna Tashchuk, Olha Myronova, Thang Huy Nguyen, Tan Van Vo, Thanh T. Tran, Nga Thi Phuong Nguyen, Anh Dat Nguyen, Binh Thanh Nguyen, Thang Ba Nguyen, Ngoc Hoang Nguyen, Dinh Quang Nguyen, Nhan Duc Le, Dai Dinh Pham · 发表于：JAMA Neurology · 年份：2020 · DOI：10.1001/jamaneurol.2020.4396 · 被引用次数：44 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Acute Ischemic Stroke Management、Atherosclerosis and Cardiovascular Diseases

IMPORTANCE: Reduction of subsequent disabling stroke is the main goal of preventive treatment in the acute setting after transient ischemic attack (TIA) or minor ischemic stroke. OBJECTIVE: To evaluate the superiority of ticagrelor added to aspirin in preventing disabling stroke and to understand the factors associated with recurrent disabling stroke. DESIGN, SETTING, AND PARTICIPANTS: The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) was a randomized clinical trial conducted between January 22, 2018, and December 13, 2019, with a 30-day follow-up, at 414 hospitals in 28 countries. The trial included 11 016 patients with a noncardioembolic, nonsevere ischemic stroke or high-risk TIA, including 10 803 with modified Rankin Scale score (mRS) recorded at 30 days. INTERVENTIONS: Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily for days 2-30) or placebo within 24 hours of symptom onset. All patients received aspirin, 300 to 325 mg on day 1 followed by 75 to 100 mg daily for days 2 to 30. MAIN OUTCOMES AND MEASURES: Time to the occurrence of disabling stroke (progression of index event or new stroke) or death within 30 days, as measured by mRS at day 30. Disabling stroke was defined by mRS greater than 1. RESULTS: Among participants with 30-day mRS greater than 1, mean age was 68.1 years, 1098 were female (42.6%), and 2670 had an ischemic stroke (95.8%) as a qualifying event. Among 11 0...