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Dual antiplatelet therapy with ticagrelor may increase the risk of all bleeding events in patients with minor strokes or high risk TIAs: a meta-analysis

Xi Chen, Jiawen Xu, Shidong Chen, Qiang Dong, Yi Dong
DOI: 10.1136/svn-2021-001423 Published 2 September 2022
Xi Chen
Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
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Jiawen Xu
Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
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Shidong Chen
Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
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Qiang Dong
Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
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Yi Dong
Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
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    Figure 1

    Forest plot of haemorrhagic events. (A) Forest plot of all bleeding events; (B) Forest plot of intracranial haemorrhage; (C) Forest plot of severe or moderate bleeding events; (D) Forest plot of fatal bleeding events. A, aspirin; C+A, clopidogrel plus aspirin; T+A, ticagrelor plus aspirin; CHANCE 2, Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II; PRINCE, Platelet Reactivity in Acute Stroke or Transient Ischaemic Attack; THALES, Ticagrelor and ASA for Prevention of Stroke and Death; RR, raletive risk; CI, Confidence Interval.

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    Figure 2

    Forest plot of stroke events. (A) Forest plot of stroke recurrence; (B) forest plot of TIA recurrence. A, aspirin; C+A, clopidogrel plus aspirin; T+A, ticagrelor plus aspirin; CHANCE 2, Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II ; PRINCE, Platelet Reactivity in Acute Stroke or Transient Ischaemic Attack; THALES, Ticagrelor and ASA for Prevention of Stroke and Death; TIA, transient ischaemic attack; RR, raletive risk; CI, Confidence Interval.

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    Figure 3

    Forest plot of death. A, aspirin; C+A, clopidogrel plus aspirin; T+A, ticagrelor plus aspirin; CHANCE 2, Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II; PRINCE, Platelet Reactivity in Acute Stroke or Transient Ischaemic Attack; THALES, Ticagrelor and ASA for Prevention of Stroke and Death; RR, raletive risk; CI, Confidence Interval.

Tables

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  • Table 1

    The intervention of ticagrelor related stroke trials

    TrailsInterventionControlDuration
    THALESTicagrelor 180 mg loading dose followed by 90 mg two times per day plus aspirinAspirin30 days
    PRINCETicagrelor 180 mg loading dose followed by 90 mg two times per day plus aspirinClopidogrel 300 mg loading dose followed by 75 mg daily plus aspirin21 days
    CHANCE 2Ticagrelor 180 mg loading dose followed by 90 mg two times per day plus aspirinClopidogrel 300 mg loading dose followed by 75 mg daily plus aspirin21 days
    SOCRATESTicagrelor 180 mg loading dose followed by 90 mg two times per dayAspirin90 days
    • CHANCE 2, Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II; PRINCE, Platelet Reactivity in Acute Stroke or Transient Ischaemic Attack; SOCRATES, Stroke or Transient Ischaemic Attack Treated with Aspirin or Ticagrelor and Patient Outcomes; THALES, Ticagrelor and ASA for Prevention of Stroke and Death.

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Stroke and Vascular Neurology: 7 (4)
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Dual antiplatelet therapy with ticagrelor may increase the risk of all bleeding events in patients with minor strokes or high risk TIAs: a meta-analysis
Xi Chen, Jiawen Xu, Shidong Chen, Qiang Dong, Yi Dong
Stroke and Vascular Neurology Aug 2022, 7 (4) 271-275; DOI: 10.1136/svn-2021-001423

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Dual antiplatelet therapy with ticagrelor may increase the risk of all bleeding events in patients with minor strokes or high risk TIAs: a meta-analysis
Xi Chen, Jiawen Xu, Shidong Chen, Qiang Dong, Yi Dong
Stroke and Vascular Neurology Aug 2022, 7 (4) 271-275; DOI: 10.1136/svn-2021-001423
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Dual antiplatelet therapy with ticagrelor may increase the risk of all bleeding events in patients with minor strokes or high risk TIAs: a meta-analysis
Xi Chen, Jiawen Xu, Shidong Chen, Qiang Dong, Yi Dong
Stroke and Vascular Neurology Aug 2022, 7 (4) 271-275; DOI: 10.1136/svn-2021-001423
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