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.