The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) study was designed to test the hypothesis that 30-day treatment with ticagrelor and aspirin would be superior to aspirin alone in reducing the risk of subsequent stroke or death in patients who had a non-cardioembolic ischemic stroke or transient ischemic attack.
It is well documented that influenza epidemics are associated with an increased risk of ischemic stroke and myocardial infarction, as are all systemic inflammatory disorders. Investigators at Weill Cornell Medicine wanted to determine if coronavirus infection induced a higher risk of ischemic stroke than other viral infections, such as influenza.
A recent advance in ischemic stroke treatment is the mobile stroke unit, an ambulance outfitted with specialized equipment, computed tomography for brain imaging, and a specialized team with a stroke neurologist available either onboard or via telemedicine. Intravenous thrombolytics can be administered at the scene with the patient on the ambulance.
Endovascular mechanical thrombectomy has become the standard treatment for patients with acute ischemic stroke caused by large vessel occlusion in both the anterior and posterior circulations. This is predicated on the ability to perform the procedure in a timely fashion or based on a mismatch between the size of infarction and brain perfusion.
Cilostazol is a phosphodiesterase 3 inhibitor widely used in Asia for secondary stroke prevention but approved for use in North America only for symptomatic peripheral vascular disease. It has been theorized that cilostazol might be beneficial in preventing the progression of small vessel disease in the brain and, therefore, may have a secondary effect in preventing vascular dementia.
Following ischemic stroke in patients with non-valvular atrial fibrillation, the timing to restart anticoagulation treatment is uncertain and controversial. In addition, there is little data available regarding timing to restart anticoagulation following reperfusion therapy with either systemic thrombolysis and/or mechanical thrombectomy.
Neurological symptoms and impairments have been found in one-third of hospitalized patients with COVID-19 from countries that have reported these observations so far. This is a rapidly evolving consequence of SARS-CoV-2 infection.
Although the data from this analysis suggest disability might be less with dual antiplatelet therapy, differences between the groups were small, did not show robust findings, and did not reach statistical significance in most of the analyses.