ABSTRACT NUMBER: ESOC2026A320 TICAGRELOR PLUS ASPIRIN VERSUS CILOSTAZOL PLUS ASPIRIN IN THE ACUTE-PHASE TREATMENT OF LARGE-VESSEL MINOR STROKE OR TIA: A RANDOMIZED CONTROLLED MULTI-CENTER TRIAL, THE TACTIS TRIAL

Abstract Background and aims More intensive antiplatelet agents may reduce recurrent stroke risk in minor stroke. Cilostazol is cheaper than ticagrelor. We evaluated the benefits or hazards of adding cilostazol or ticagrelor to aspirin in patients with minor LVO ischemic stroke or TIA. Methods We randomized 900 first-ever, LVO minor ischemic stroke or TIA patients in a one-to-one ratio to receive a 200 mg loading dose of cilostazol within 24 hours after acute stroke symptoms, then 100 mg twice daily until day 90 post-stroke, or a 180 mg loading dose of ticagrelor during the first 24 hours, followed by 90 mg twice daily till day 90. Both groups received an open-label 300 mg loading dose of aspirin during the first 24 hours, then 75 mg once daily. The follow-up period was 3 months. Results 34 (7.6%) patients in cilostazol group and 29 (6.4%) patients in ticagrelor group experienced a new stroke (HR 1.37; 95% CI, 0.84-2.26; P-value= 0.21), 44 (9.8%) patients in cilostazol group and 40 (8.9%) patients in ticagrelor group experienced a composite of a new stroke, MI, or death due to vascular insults (HR 1.11; 95% CI, 0.64-1.93; P-value= 0.30). Fifteen (3.3%) patients in cilostazol arm and 30 (6.7%) patients in ticagrelor arm experienced drug-related hemorrhagic complications (HR 0.32; 95% CI, 0.19–0.68; P-value = 0.01). Conclusions Combining cilostazol with aspirin in LVO minor ischemic stroke or TIA was as effective as ticagrelor and aspirin in preventing recurrent stroke, MI, and death due to vascular events, but resulted in significantly lower rates of hemorrhagic complications. Conflict of interest all authors declare no coflict of interests