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StrokeJuly 2020

What the THALES Trial Found — Ticagrelor + Aspirin After Mild Stroke

THALES tested whether adding ticagrelor to aspirin in the first 24 hours after a mild stroke or TIA prevents another stroke. Across 11,016 patients followed for 30 days, the combination cut the risk of a second stroke or death — but caused more serious bleeding.

What the trial was testing

The THALES enrolled 11,016 patients with stroke. The study was sponsored by AstraZeneca and tracked outcomes across the full group of patients who matched the trial's eligibility profile.

It was a large trial designed to confirm whether the treatment works well enough for wider use. Trials at this stage are designed to produce evidence regulators and physicians can act on — not just observations to follow up later.

What the results showed

17% lower risk of stroke or death within 30 days vs. aspirin alone.

New England Journal of Medicine · 2020 · NCT03354429

These findings — that of stroke or death in 30 days when ticagrelor is added to aspirin after mild ischemic stroke or TIA — were published in the New England Journal of Medicine and represent the headline result of the study.

Researchers tracked outcomes across 11,016 patients enrolled in the trial. The result was consistent enough across the group that the team felt confident reporting it.

What this means for patients

For patients with stroke, this result changes the calculus on what to ask their care team about. Whether it changes day-to-day care depends on factors like disease subtype, prior treatments, and where the patient is in their care journey.

What you can do now

Ticagrelor (Brilinta) plus aspirin is FDA-approved for stroke prevention after a mild stroke or TIA and available now. Treatment is short — usually 30 days — to limit bleeding risk. Talk to a neurologist quickly after stroke symptoms; this regimen only works if started within 24 hours of symptom onset.

Eligibility for the treatments mentioned above depends on specific test results and clinical history. Bring this summary, the trial name, and your most recent labs or pathology report to your next visit.