JAMA N: Evidence of dual antibody treatment for patients with NIHSS scores of 4 and 5

Dual antiplatelet therapy (Dual antiplatelet therapy, DAPT) is a key strategy for early management of mild non-cardiac ischemic stroke and TIA
.

In the THALES trial, the efficacy of combined ticagrelor and aspirin in patients with TIA or acute ischemic stroke with NIHSS score <= 5 was evaluated.
About 30% of patients had NIHSS scores of 4 or 5 at the time of randomization
.

In September 2021, Professor Wang Yongjun from Beijing Tiantan Hospital announced the results of the exploratory subgroup analysis of the THALES trial on JAMA Neurology, evaluating the effectiveness of ticagrelor combined with aspirin in the treatment of moderate ischemic stroke (NIHSS score 4-5) Efficacy and safety
.

The THALES trial is a randomized trial conducted in 414 hospitals in 28 countries in January 2018 and December 2019
.

There were a total of 3312 patients with moderate stroke and 6,671 patients with mild stroke
.

The incidence of the main outcome event in the ticagrelor group (DAPT) of patients with stroke was 7.
6% (129 out of 1671), and in the placebo group (aspirin group) it was 9.
1% (150 out of 1641) (HR, 0.
84) ; 95% CI, 0.
66-1.
06); the main outcome event rate of patients with mild stroke in the ticagrelor group was 4.
7% (158 out of 3359 cases), and 5.
7% in the placebo group (190 out of 3312 cases) (HR , 0.
82; 95% CI, 0.
66-1.
01) (interaction P=0.
88)
.

Ultimately, the author believes that in this study, the benefits of ticagrelor combined with aspirin (vs aspirin alone) in patients with moderate ischemic stroke are consistent with the benefits of patients with mild ischemic stroke.

Original source:

Yongjun Wang, Yuesong Pan, Hao Li, et al.