Recent trials have evaluated the use of aspirin to prevent stroke after an ischemic stroke or transient ischemic attack (TIA). While ticagrelor alone is not better than aspirin in preventing vascular events after stroke, its effect in combination with aspirin is not clearly established. This objective of this study is to compare the effectiveness of aspirin versus aspirin and ticagrelor to prevent stroke or death after ischemic stroke or TIA. 

This is a randomized, placebo-controlled, double-blind trial, including a total of 11,106 patients who had a mild-moderate acute ischemic stroke or TIA. The patients were divided into two groups in a 1:1 ratio; one group was assigned aspirin (n=5,493), and the other was assigned ticagrelor-aspirin (n=5,523). Both groups received a 30-day regimen 24 hours after symptom onset. 

The incidence of a primary-outcome event was more common in the aspirin group (6.6%) than in the ticagrelor-aspirin group (5.5%). Ischemic stroke occurred in 345 (6.3%) patients in the aspirin group and 276 (5.0%) patients in the ticagrelor-aspirin. However, the difference was not significant, and the incidence of disability was almost similar in the two groups. 

The research concluded that the risk of stroke or death in ischemic stroke or TIA patients was lower with ticagrelor-aspirin than with aspirin alone. 

Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa1916870