6/29/23, 11:45 PM SOCRATES Pathway Feedback Search Clinical Topics Home Studies SOCRATES SOCRATES Disease Disease Acute ischemic stroke Transient ischemic attack Trial question What is the effect of ticagrelor in patients with acute ischemic stroke or TIA? Study design Multi-center Double blinded RCT Population Characteristics of study participants 42.0% female N = 13199 58.0% male 13199 patients (5483 female, 7716 male) Inclusion criteria: patients with nonsevere ischemic stroke or high-risk TIA who had not received intravenous or intraarterial thrombolysis and were not considered to have ha a cardioembolic stroke Key exclusion criteria: specific antiplatelet therapy or anticoagulation therapy was planned or if carotid, cerebrovascular, or coronary revascularization was planned that would require halting study treatment within 7 days after randomization; hypersensitivity to ticagrelor or aspirin; history of AF, ventricular aneurysm, or suspicion of cardioembolic cause for TIA or stroke; underwent intravenous or intraarterial thrombolysis or mechanical thrombectomy within 24 hours before randomization Interventions https://web.pathway.md/studies/rec3J5Si17H1GrXYC 1/2 6/29/23, 11:45 PM SOCRATES Pathway N=6589 ticagrelor (180 mg loading dose on day 1 followed by 90 mg BID for days 2 through 90) N=6610 aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90) Primary outcome Time to occurrence of stroke, myocardial infarction, or death at 90 days 7.5 % 7.5 6.7 5.6 % 3.8 % 1.9 % No significant difference 0.0 % Ticagrelor Aspirin No significant difference in time to occurrence of stroke, myocardial infarction, or death at 90 days (6.7% vs. 7.5%; HR 0.89, 95% CI 0.78 to 1.01) Secondary outcomes Borderline significant decrease in ischemic stroke (5.8% vs. 6.7%; HR 0.87, 95% CI 0.76 to 1) Safety outcomes No significant differences in major bleeding (0.5% vs. 0.6%), intracranial hemorrhage (0.2% vs. 0.3%), and fatal bleeding (0.1% vs. 0.1%). Conclusion In patients with nonsevere ischemic stroke or high-risk TIA who had not received intravenous or intraarterial thrombolysis and were not considered to have ha a cardioembolic stroke, ticagrelor was not superior to aspirin with respect to time to occurrence of stroke, myocardial infarction, or death at 90 days. Reference Johnston SC, Amarenco P, Albers GW et al. Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack. N Engl J Med. 2016 Jul 7;375(1):35-43. Open reference URL https://web.pathway.md/studies/rec3J5Si17H1GrXYC 2/2