IM Article

The title of the article is Comparison of Ticagrelor vs Clopidogrel in Addition to Aspirin in Patients With Minor Ischemic Stroke and Transient Ischemic Attack. A Network Meta-analysis. The article was published in JAMA in December 2021. The first author is Ronda Lun. The objective of the study is to compare ticagrelor and aspirin with clopidogrel and aspirin in patients with TIA in the prevention of recurrent strokes or death. This meta-analysis included 22098 patients from 5 RCTs. The primary outcome was recurrent stroke or death up to 90 days. Secondary outcomes include major bleeding, mortality, adverse events, and functional disability. They found that both combinations were superior to aspirin alone in the prevention of recurrent stroke and death. There was no statistically significant difference between clopidogrel, and aspirin compared with ticagrelor and aspirin in the prevention of recurrent stroke or death up to 90 days. Both regimens had higher rates of major hemorrhage than aspirin alone, but no difference noted between the two DAPT regimens. Clopidogrel and aspirin was associated with a lower risk of functional disability compared to other regimens. There are a few limitations with this meta-analysis. First, potential data from nonrandomized studies may be overlooked because the analysis only included RCTs. Second, the treatment duration varies between the studies. Also, due to the incomplete reporting of specific outcomes across trials, some outcomes, such as ischemic stroke alone at 30 days cannot be analyzed.