What are the benefits and risks associated with the use of ticagrelor plus aspirin for the subgroup of patients with ipsilateral carotid artery stenosis and intracranial stenosis?
The use of ticagrelor plus aspirin for the subgroup of patients with ipsilateral carotid artery stenosis and intracranial stenosis has been shown to be slightly superior to aspirin alone in preventing recurrent stroke (recurrent stroke rate, 5% versus 6.3%; P=0.004). However, it was also associated with significantly increased risk of severe bleeding (0.5% versus 0.1%; P=0.01). The number needed to treat to prevent 1 primary outcome event was 92, and the number needed to harm was 263 for severe bleeding. A meta-analysis suggested that, among the 4 studies that examined stroke outcomes, there was a reduced risk of recurrent stroke among patients who switched from 1 antiplatelet agent to another or to DAPT. However, both of the RCTs that specifically examined recurrent stroke used DAPT rather than switching antiplatelets.