Methodology: 2/5
Usefulness: 2/5

Johnston SC, et al. N Engl J Med. 2020 Jul 16;383(3):207-217.

Question and Methods: Multicentre, double-blind RCT of ASA vs Ticagrelor-ASA among 11016 patients with high-risk TIA or minor stroke for prevention of stroke/death within 30 days.
Findings: Ticagrelor-ASA decreased overall rates of stroke/death (5.5 vs 6.6%, HR 0.83; 95% CI 0.71-0.96). However, there was no difference in disability, and more severe and intracranial bleeding with combination therapy.
Limitations: Industry was heavily involved

Interpretation: Insufficient evidence to recommend ticagrelor-ASA for secondary stroke prevention. Previous evidence suggests Clopidogrel-ASA has fewer side effects especially when limited to 21 days. 

By: Dr. Michael Wong


  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.