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Background <p>A transient ischemic attack (TIA) or ischemic stroke often signals a high risk of another event, especially in the days following. While aspirin and clopidogrel are standard treatments, their limitations, such as genetic resistance to clopidogrel, have led to interest in ticagrelor as an alternative. We aimed to address this by comparing the efficacy and safety of ticagrelor (either as monotherapy or in combination with aspirin) with those of aspirin or clopidogrel.</p> Methods <p>This systematic review and meta-analysis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Web of Science, and Cochrane databases were comprehensively searched to identify randomized controlled trials comparing ticagrelor alone or with aspirin versus aspirin, clopidogrel, or clopidogrel plus aspirin. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.</p> Results <p>This study included 32,782 patients with ischemic stroke or TIA. Ticagrelor-based regimens lowered the risk of ischemic stroke (OR = 0.81; 95% CI: 0.75–0.88), with the strongest benefit observed with clopidogrel alone. Composite vascular events were also reduced (OR = 0.78; 95% CI: 0.68–0.89), particularly with ticagrelor plus aspirin. However, ticagrelor increased the risk of bleeding (OR = 2.04; 95% CI: 1.63–2.55), fatal bleeding (OR = 2.22; 95% CI: 1.02–4.79), and hemorrhagic stroke (OR = 1.53; 95% CI: 1.02–2.30).</p> Conclusions <p>Early initiation of ticagrelor after TIA or ischemic stroke can significantly reduce recurrent vascular events, particularly in patients with clopidogrel resistance. However, this benefit comes with a higher risk of serious bleeding, underscoring the importance of careful patient selection and individualized treatment planning.</p>

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Ticagrelor versus clopidogrel or aspirin in transient ischemic attack (TIA) or ischemic stroke: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月25日

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  • Hussain Ali Almohammed,
  • Bayan Mohammed Khair Al Zoabi,
  • Husna Irfan Thalib,
  • Lamees A. Alhajri,
  • Jakleen Ziyad Abujamai,
  • Rimas Warid Aljuaid,
  • Jory H. Alzahrani,
  • Jana M. Alsyrwan,
  • Mohammed Fadhel Alwabari,
  • Nawaf Abdullah Alghafli,
  • Saud A. Alnaaim

摘要

Background

A transient ischemic attack (TIA) or ischemic stroke often signals a high risk of another event, especially in the days following. While aspirin and clopidogrel are standard treatments, their limitations, such as genetic resistance to clopidogrel, have led to interest in ticagrelor as an alternative. We aimed to address this by comparing the efficacy and safety of ticagrelor (either as monotherapy or in combination with aspirin) with those of aspirin or clopidogrel.

Methods

This systematic review and meta-analysis adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Web of Science, and Cochrane databases were comprehensively searched to identify randomized controlled trials comparing ticagrelor alone or with aspirin versus aspirin, clopidogrel, or clopidogrel plus aspirin. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random-effects model.

Results

This study included 32,782 patients with ischemic stroke or TIA. Ticagrelor-based regimens lowered the risk of ischemic stroke (OR = 0.81; 95% CI: 0.75–0.88), with the strongest benefit observed with clopidogrel alone. Composite vascular events were also reduced (OR = 0.78; 95% CI: 0.68–0.89), particularly with ticagrelor plus aspirin. However, ticagrelor increased the risk of bleeding (OR = 2.04; 95% CI: 1.63–2.55), fatal bleeding (OR = 2.22; 95% CI: 1.02–4.79), and hemorrhagic stroke (OR = 1.53; 95% CI: 1.02–2.30).

Conclusions

Early initiation of ticagrelor after TIA or ischemic stroke can significantly reduce recurrent vascular events, particularly in patients with clopidogrel resistance. However, this benefit comes with a higher risk of serious bleeding, underscoring the importance of careful patient selection and individualized treatment planning.