Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial

Recent advances in preventing stroke recurrence

“…Ticagrelor, an antiplatelet agent that acts by the same mechanism (inhibition of the platelet ADP receptor P2Y12), avoids this problem because the parent drug is active 64 . Although in the main trial ticagrelor did not significantly reduce stroke, it has been shown that ticagrelor reduced stroke among Asian participants 65 and also that ticagrelor reduced recurrent stroke among study participants with large artery disease 66 . As a clinical pharmacologist, I expect that ticagrelor will replace clopidogrel for secondary stroke prevention.…”

Relationship between left atrial volume and ischemic stroke subtype

“…It is likely that a substantial proportion of ESUS cases results from large‐artery atherosclerotic plaques that are currently unrecognized because they do not cause >50% stenosis of the arterial lumen . This heterogeneity in the ESUS population may explain the lack of benefit of anticoagulant therapy in the overall ESUS population, since atherosclerotic lesions may respond more favorably to strong antiplatelet therapy …”

Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table

“…Emerging data suggest different stroke subtypes may respond differentially to antiplatelet agents, with atherosclerotic stroke particularly benefitting from more intensive antiplatelet therapy in the first few weeks after the event, 30 while small artery stroke had a worse outcome with aspirin and clopidogrel than aspirin alone, showing no reduction of ischaemic stroke and an increased bleeding risk. 31 Future trials are warranted to focus on a precision medicine approach to identify patients who have the greatest likelihood of benefit and least likelihood of harm.…”