New treatment for Acute ischemic Stroke

Topline results from the phase 3 THALES trial show that in patients who had experienced an acute ischemic stroke or transient ischemic attack (TIA), the antiplatelet agent ticagrelor (Brilinta, AstraZeneca), in combination with aspirin, demonstrated a statistically significant reduction in the rate of repeat stroke or death compared to placebo.

THALES was conducted in more than 11,000 patients who had experienced a minor acute ischemic stroke or high-risk TIA and for whom treatment was initiated within 24 hours of the onset of symptoms. The patients were randomly assigned to receive aspirin plus ticagrelor (90 mg twice daily) or aspirin alone for 30 days.

The primary endpoint ― the composite of stroke and death at 30 days ― showed a statistically significant and clinically meaningful reduction in the ticagrelor group.

The full THALES trial results will be presented at a forthcoming medical meeting.

These initial results from THALES follow the POINT trial, which was reported in 2018. In that trial, a combination of clopidogrel plus aspirin reduced major ischemic events, including ischemic stroke, myocardial infarction, or death from ischemic vascular causes, compared with aspirin alone in patients with minor ischemic stroke or high-risk TIA.

Although there was also an increase in bleeding with the dual antiplatelet therapy in the POINT trial, this was said to be outweighed by the reduction in ischemic events.