A novel drug to prevent stroke in patients with cardiovascular risk factors

This meta-analysis examined the safety and effectiveness of ticagrelor (Brilinta) to prevent stroke. The authors concluded that ticagrelor was safe and effective at preventing stroke, heart attack and cardiovascular death in patients with cardiovascular risk factors.

Ticagrelor (Brilinta) is a medication used to prevent blood clots. Early studies showed that ticagrelor was safe and effective at preventing stroke in patients with acute coronary syndromes (blocked blood flow to the heart). In other studies however, it was no better than aspirin at preventing stroke in patients with other conditions. Therefore it was unclear whether ticagrelor would be beneficial for those with multiple risk factors for first or second stroke.

This meta-analysis looked at the safety and effectiveness of ticagrelor in the treatment of patients with vascular (blood vessels) risk factors.

The authors included 13 trials with a combined 64,360 patients who were treated with ticagrelor or a control drug. The average follow-up was 6 months.

Compared to the control group, patients treated with ticagrelor had 14% lower risk of ischemic stroke (blocked artery to the brain). Treatment with ticagrelor also reduced the risk of ischemic and hemorrhagic (burst blood vessel in the brain) stroke.  When the rates of stroke, heart attack and cardiovascular death were combined, patients treated with ticagrelor had a 10% reduced risk compared to the control treatment.

There was no increase in the risk of death or major bleeding events after treatment with ticagrelor compared to control treatments, however there was a slight increase in the risk of bleeding events. Treatment with ticagrelor increased the risk of elevated blood uric acid levels by 54% which can lead to kidney stones or gout. Furthermore, treatment with ticagrelor increased the risk of dyspnea (breathing difficulties) 3-fold.

Further analysis including only patients with a history of ischemic stroke showed that treatment with ticagrelor decreased the risk of recurrent stroke by 13% and the risk of stroke, heart attack and cardiovascular death by 12% compared to control treatments.

The authors concluded that ticagrelor is effective and safe at preventing stroke in patients with cardiovascular risk factors.