Evaluating Ticagrelor's Stroke-Prevention Efficacy in High-Risk Patients

High-risk patients with a history of myocardial infarction have lower stroke risk after taking ticagrelor 60 mg twice per day, but those with coronary disease need a more intensive therapy, according to a recent study.

High-risk patients with a history of myocardial infarction have lower stroke risk after taking ticagrelor 60 mg twice per day, but those with coronary disease need a more intensive therapy, according to a recent study. Published ahead of print on August 30, 2016, on the website for the journal Circulation, the study was authored by Marc Bonaca, MD, MPH of Brigham and Women’s Hospital in Boston, MA, and colleagues.

The researchers used data from the PEGASUS-TIMI 54 trial (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-thrombolysis in Myocardial Infarction 54) to explore “the incidence, predictors, and subsequent outcomes of stroke,” and “the effect of the approved 60-mg dose added to aspirin on the risk of stroke.”

“In the present patient population, at high risk for stroke but largely without a history of prior stroke, long-term secondary prevention with ticagrelor 60 mg twice daily added to low-dose aspirin reduced all stroke,” say the researchers, adding “the benefit of ticagrelor was consistent across key clinical subgroups.” They also found that a more intensive antiplatelet strategy led to a 34% reduction in ischemic stroke, as well as an overall reduction in the incidence of stroke. However, they caution that these findings do not apply to all populations and should be “considered within the limitations of the meta-analysis presented.”

High risk patients with a history of myocardial infarction have a long-term risk of stroke, and the outcomes in such patients are generally poor, with more than 30% resulting in disability or death. Adding a second antiplatelet agent to aspirin can reduce the risk by approximately 34% in a population of patients with coronary disease. The researchers conclude by saying, “Stroke prevention should be considered when weighing the risks and benefits of long-term antiplatelet therapy in high-risk patients with coronary disease.”

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