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Ticagrelor versus Aspirin in Acute Stroke or Transient Ischemic Attack

Journal Club Summary

Methodology Score: 5/5                   
Usefulness Score:  3.5/5

Johnston SC, et al.
N Engl J Med. 2016 Jul 7;375(1):35-43.
Full Article

This large international double-blind double-dummy RCT across 33 countries and including 13,199 patients did not show a benefit of ticagrelor over ASA in reducing composite outcome of stroke, MI, or death at 90 days after a minor stroke or high-risk TIA.  With respect to antiplatelet monotherapy for stroke secondary prevention, the findings of this rigorous study diminish the potential role of ticagrelor.
By: Dr. Miguel Cortel  


Epi lesson

The NNT concept was created By: Canadian Clinical Epidemiologist Dr Andreas Laupacis in 1988 to quantify the benefit of a new intervention.  NNT is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need to be treated for one to benefit compared with a control in a clinical trial). It is easily calculated as the inverse of the absolute risk reduction (1/ARR). The higher the NNT the less effective the treatment. http://www.nejm.org/doi/full/10.1056/NEJM198806303182605

By: Dr. Ian Stiell

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