ABSTRACT NUMBER: ESOC2026LT46 LT46 - EARLY TICAGRELOR-ASPIRIN FOR STROKE TREATED WITH INTRAVENOUS THROMBOLYSIS

Abstract Background and aims Evidence supporting early addition of antiplatelet therapy to intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) remains inconclusive. The TAPIS trial aimed to evaluate the efficacy and safety of early oral dual antiplatelet therapy (DAPT) as an adjunct to IVT. Methods This randomized, double-blind, placebo-controlled trial was conducted in 60 hospitals across China and enrolled AIS patients treated with IVT with a pre-IVT National Institutes of Health Stroke Scale score of 4 to 10. Eligible patients were randomized in a 1:1 ratio to receive . The primary efficacy outcome was excellent functional outcome (modified Rankin scale score of 0 to 1) at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 36 hours. Results A total of 690 patients were assigned to early DAPT and 692 to placebo. The median age was 65.6 years, and 71.7% were men. At 90 days, 474 (68.7%) patients in the early DAPT group and 429 (62.0%) in the placebo group achieved excellent functional outcome (risk ratio,1.11; 95% CI, 1.03 to 1.20; P=0.009). SICH within 36 hours occurred in 6 (0.9%) and 5 (0.7%) patients, respectively. Conclusions Among IVT-treated patients with moderate AIS, early initiation of DAPT improved the likelihood of excellent functional outcome at 90 days without increasing risk of sICH. Conflict of interest