Combining Aspirin With Ticagrelor or Clopidogrel in Large-vessel Minor Stroke or TIA

Last updated: September 8, 2024
Sponsor: Kafrelsheikh University
Overall Status: Active - Recruiting

Phase

3

Condition

Stroke

Cardiac Ischemia

Blood Clots

Treatment

Ticagrelor 90 MG

Clopidogrel

Clinical Study ID

NCT06591338
2309881671459
  • Ages 18-75
  • All Genders

Study Summary

Along with the current clinical trial, the efficacy and safety of a 180 mg loading dose of ticagrelor administered within 24 hours of the first-ever large-vessel minor stroke or TIA compared to 300 mg clopidogrel were assessed through NIHSS, mRS, and possible adverse effects.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • the investigators included both genders with eligible ages ranging between 18-75years, with the first-ever presentation with large-vessel minor ischemic stroke orTIA who received antiplatelet treatment within the first 24 hours of the onset ofischemic stroke. Patients are not eligible for rt-PA treatment

Exclusion

Exclusion Criteria:

  • The investigators excluded patients who had not been followed up on for 90 daysafter enrollment, those with NIHSS < 5 or who had rapidly resolving symptoms beforeimaging results, and patients with a known history of persistent or recurrent CNSpathology (e.g., epilepsy, meningioma, multiple sclerosis, history of head traumawith a residual neurological deficit).

The investigators excluded patients who had clinical seizures at the onset of their stroke, as well as those who had symptoms of any major organ failure, active malignancies, or an acute myocardial infarction within the previous six weeks, and those who were on warfarin, regular ticagrelor during the week before admission, or chemotherapy within the previous year.

The investigators excluded patients with active peptic ulcers, GIT surgery, bleeding history within the last year, and those with a history of major surgery within the last three months.

The investigators ruled out our trial patients who had a known allergy to the study drugs and those with INR > 1.4 or P.T. >18 or blood glucose level < 50 or > 400 mg/DL or blood pressure < 90/60 or > 185/110 mmHg on admission or Platelets < 100,000.

The investigators excluded pregnant and lactating patients and those with stroke due to venous thrombosis and stroke following cardiac arrest or profuse hypotension ineligible for our trial.

Patients with contraindications to the study drugs were excluded.

Study Design

Total Participants: 900
Treatment Group(s): 2
Primary Treatment: Ticagrelor 90 MG
Phase: 3
Study Start date:
April 01, 2022
Estimated Completion Date:
September 30, 2024

Study Description

The investigators conducted a single-blinded randomized controlled trial after the ethics committee of the faculty of medicine at Kafr el-Sheik University approved it.

The investigators got written informed consent from all eligible patients or their first order of kin before randomization.

The study will be composed of 2 arms ticagrelor arm, which consisted of 450 patients who received a 180mg loading dose followed by 90 mg twice daily from the 2nd to the 90th day), and the clopidogrel arm, consisting of 450 patients who received (a 300mg loading dose during the first 24 hours of stroke onset followed by 75mg once daily from the 2nd day to the 90th day),

Study Procedures:

Every patient in our study will undergo:

Clinical workup: History, clinical assessment & NIHSS were recorded on admission, day 7, and the Modified Rankin Scale as a follow-up after one week and 3 months.

Detection of Risk Factors & Profiles:

Echocardiography TTE: in indicated patients ECG Monitoring: daily ECG monitoring will be performed in indicated patients. 3- Carotid Duplex: carotid duplex in indicated patients.

4- ESR & Lipid Profile& liver functions: All will be tested routinely for all patients.

Imaging Follow-UP Non-contrast CT brain on admission Day 2 MRI: after two days of admission, all the patients in this study will have a brain MRI (stroke protocol; T1W, T2W, FLAIR, DWI, T2 Echo Gradient, MRA of all intra-cerebral vessels).

CT brain: Any patient with unexplained clinical deterioration at any time throughout his/her hospital stay will be urgently imaged by CT.

Primary End Point:

The primary efficacy outcome was the rate of new stroke at 90 days, and the primary safety outcome was the rate of drug hemorrhagic complications using the PLATO bleeding definition.

• Secondary End Point: The secondary efficacy outcomes were to evaluate the rates of patients who achieved a significant reduction in NIHSS (decrease of four points or more) at the seventh day or discharge compared to baseline, the rates of a favorable outcome with (mRS = 0-2) after one week and after 90 days in a face-to-face interview in the outpatient clinic, rates of a composite of recurrent stroke, myocardial infarction and death due to vascular events after 90 days of follow-up, while the secondary safety outcome was the rate of treatment-related adverse effects assessed by a follow-up questionnaire

Connect with a study center

  • Kafr Elsheikh University Hospital

    Kafr Ash Shaykh, 33511
    Egypt

    Active - Recruiting

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