{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T19:47:50Z","timestamp":1779911270234,"version":"3.53.1"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T00:00:00Z","timestamp":1669766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Kafr El Shiekh University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol Sci"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract\n<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Ticagrelor is one of the most recent antiplatelet drugs to be approved to treat ischemic heart disease. Its efficacy may exceed aspirin in improving clinical outcomes in patients with acute ischemic stroke who are ineligible for rt-PA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>We evaluated the safety regarding hemorrhagic complications (as a primary endpoint) and the efficacy (as a secondary endpoint) of a 180-mg loading dose of ticagrelor given within 9\u00a0h from the onset of the first-ever non-cardioembolic ischemic stroke.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted our study on patients aged 18\u201375\u00a0years who presented with their first clinically manifested non-cardioembolic ischemic stroke and were recruited from the emergency department OF Kafr El-Sheik University Hospitals, Egypt.<\/jats:p>\n                <jats:p>Eligible patients randomly received ticagrelor or aspirin loading and maintenance doses. Screening, randomization, and initiation of treatment all occurred within the first 9\u00a0h of stroke onset.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Eighty-five patients received ticagrelor, and 84 received aspirin. Patients who received ticagrelor had a better clinical outcome in terms of NIHSS improvement at 2\u00a0days and 1\u00a0week of discharge and a favorable mRS score after 1\u00a0week of discharge and at 90-day follow-up. There was no significant difference between the two groups regarding hemorrhagic adverse effects.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This pilot study found that ticagrelor had a better clinical outcome than aspirin based on NIHSS and mRS in acute ischemic stroke patients who received it within 9\u00a0h from symptom onset and had a shorter hospital stay duration. Ticagrelor was non-inferior to aspirin regarding hemorrhagic complications.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>We registered our trial on ClinicalTrials.gov, named after \u201cticagrelor versus aspirin in ischemic stroke,\u201d and with a clinical trial number (NCT03884530)\u2014March 21, 2019.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10072-022-06525-7","type":"journal-article","created":{"date-parts":[[2022,11,30]],"date-time":"2022-11-30T06:28:58Z","timestamp":1669789738000},"page":"765-771","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A randomized pilot study of the efficacy and safety of loading ticagrelor in acute ischemic stroke"],"prefix":"10.1007","volume":"44","author":[{"given":"Hany M.","family":"Aref","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hala","family":"El-Khawas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elbassiouny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hossam M.","family":"Shokri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0337-349X","authenticated-orcid":false,"given":"Mohamed G.","family":"Zeinhom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer M.","family":"Roushdy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,30]]},"reference":[{"issue":"9524","key":"6525_CR1","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1016\/S0140-6736(06)68770-9","volume":"367","author":"AD Lopez","year":"2006","unstructured":"Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006) Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367(9524):1747\u20131757","journal-title":"Lancet"},{"issue":"1","key":"6525_CR2","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.jstrokecerebrovasdis.2007.09.006","volume":"17","author":"DM Meyer","year":"2008","unstructured":"Meyer DM, Albright KC, Allison TA, Grotta JC (2008) LOAD: a pilot study of the safety of loading of aspirin and clopidogrel in acute ischemic stroke and transient ischemic attack. J Stroke Cerebrovasc Dis 17(1):26\u201329","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"13\u201314","key":"6525_CR3","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1016\/j.drudis.2010.05.011","volume":"15","author":"KA Jacobson","year":"2010","unstructured":"Jacobson KA, Boeynaems JM (2010) P2Y nucleotide receptors: promise of therapeutic applications. Drug Discov Today 15(13\u201314):570\u20138. https:\/\/doi.org\/10.1016\/j.drudis.2010.05.011","journal-title":"Drug Discov Today"},{"issue":"8","key":"6525_CR4","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1111\/ijs.12610","volume":"10","author":"SC Johnston","year":"2015","unstructured":"Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Held P et al (2015) Acute stroke or transient ischemic attack treated with aspirin or ticagrelor and patient outcomes (SOCRATES) trial: rationale and design. Int J Stroke 10(8):1304\u20131308","journal-title":"Int J Stroke"},{"issue":"3","key":"6525_CR5","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1056\/NEJMoa1916870","volume":"383","author":"SC Johnston","year":"2020","unstructured":"Johnston SC, Amarenco P, Denison H, Evans SR, Himmelmann A, James S et al (2020) Ticagrelor and aspirin or aspirin alone in acute ischemic stroke or TIA. N Engl J Med 383(3):207\u2013217","journal-title":"N Engl J Med"},{"issue":"6","key":"6525_CR6","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1159\/000210544","volume":"61","author":"M Paciaroni","year":"2009","unstructured":"Paciaroni M, Caso V, Agnelli G (2009) The concept of ischemic penumbra in acute stroke and therapeutic opportunities. Eur Neurol 61(6):321\u2013330","journal-title":"Eur Neurol"},{"issue":"1","key":"6525_CR7","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1056\/NEJMoa1603060","volume":"375","author":"SC Johnston","year":"2016","unstructured":"Johnston SC, Amarenco P, Albers GW, Denison H, Easton JD, Evans SR et al (2016) Ticagrelor versus aspirin in acute stroke or transient ischemic attack. N Engl J Med 375(1):35\u201343","journal-title":"N Engl J Med"},{"key":"6525_CR8","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1161\/STROKEAHA.118.022606","volume":"50","author":"WJ Powers","year":"2019","unstructured":"Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American Heart Association\/American. Stroke A 50:344\u2013418","journal-title":"Stroke A"},{"issue":"4","key":"6525_CR9","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/S1474-4422(13)70310-7","volume":"13","author":"RG Hart","year":"2014","unstructured":"Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O\u2019Donnell MJ et al (2014) Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 13(4):429\u2013438. https:\/\/doi.org\/10.1016\/S1474-4422(13)70310-7","journal-title":"Lancet Neurol"},{"issue":"25","key":"6525_CR10","doi-asserted-by":"publisher","first-page":"2403","DOI":"10.1161\/CIRCULATIONAHA.117.030509","volume":"136","author":"G Ntaios","year":"2017","unstructured":"Ntaios G, Hart RG (2017) Embolic stroke. Circulation 136(25):2403\u20132405","journal-title":"Circulation"},{"issue":"5","key":"6525_CR11","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","volume":"42","author":"G Hindricks","year":"2021","unstructured":"Hindricks G, Potpara T, Dagres N, Bax JJ, Boriani G, Dan GA et al (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 42(5):373\u2013498","journal-title":"Eur Heart J"},{"issue":"1","key":"6525_CR12","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1111\/j.1538-7836.2009.03678.x","volume":"8","author":"S Schulman","year":"2010","unstructured":"Schulman S, Anger SU, Bergqvist D, Eriksson B, Lassen MR, Fisher W (2010) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost 8(1):202\u2013204","journal-title":"J Thromb Haemost"},{"key":"6525_CR13","unstructured":"Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D et al (2011) New England J. 1317\u201329."},{"issue":"9558","key":"6525_CR14","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/S0140-6736(07)60149-4","volume":"369","author":"N Wahlgren","year":"2007","unstructured":"Wahlgren N, Ahmed N, D\u00e1valos A, Ford GA, Grond M, Hacke W et al (2007) Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (SITS-MOST): an observational study. Lancet 369(9558):275\u2013282","journal-title":"Lancet"},{"issue":"6","key":"6525_CR15","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1161\/01.STR.0000018645.04200.7D","volume":"33","author":"AJ Furlan","year":"2002","unstructured":"Furlan AJ (2002) Acute stroke trials: strengthening the underpowered. Stroke 33(6):1450\u20131451","journal-title":"Stroke"},{"issue":"10","key":"6525_CR16","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1161\/01.STR.31.10.2335","volume":"31","author":"JP Broderick","year":"2000","unstructured":"Broderick JP, Lu M, Kothari R, Levine SR, Lyden PD, Haley EC et al (2000) Finding the most powerful measures of the effectiveness of tissue plasminogen activator in the NINDS tPA stroke trial. Stroke 31(10):2335\u20132341","journal-title":"Stroke"},{"issue":"1","key":"6525_CR17","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1161\/STROKEAHA.116.014891","volume":"48","author":"Y Wang","year":"2017","unstructured":"Wang Y, Minematsu K, Wong KSL, Amarenco P, Albers GW, Denison H et al (2017) Ticagrelor in acute stroke or transient ischemic attack in Asian patients. Stroke 48(1):167\u2013173","journal-title":"Stroke"},{"issue":"4","key":"6525_CR18","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/S1474-4422(17)30038-8","volume":"16","author":"P Amarenco","year":"2017","unstructured":"Amarenco P, Albers GW, Denison H, Easton JD, Evans SR, Held P et al (2017) Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial. Lancet Neurol 16(4):301\u201310. https:\/\/doi.org\/10.1016\/S1474-4422(17)30038-8","journal-title":"Lancet Neurol"},{"issue":"2","key":"6525_CR19","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1161\/01.STR.25.2.278","volume":"25","author":"KF Van","year":"1994","unstructured":"Van KF, Ciabattoni G, Patrono C, Schmitz PIM, Van GJ, Koudstaal PJ (1994) Evidence for episodic platelet activation in acute ischemic stroke. Stroke 25(2):278\u2013281","journal-title":"Stroke"},{"issue":"11","key":"6525_CR20","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","volume":"361","author":"L Wallentin","year":"2009","unstructured":"Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361(11):1045\u20131057. https:\/\/doi.org\/10.1056\/NEJMoa0904327","journal-title":"N Engl J Med"}],"container-title":["Neurological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-022-06525-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10072-022-06525-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10072-022-06525-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,16]],"date-time":"2023-01-16T07:14:42Z","timestamp":1673853282000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10072-022-06525-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,30]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["6525"],"URL":"https:\/\/doi.org\/10.1007\/s10072-022-06525-7","relation":{},"ISSN":["1590-1874","1590-3478"],"issn-type":[{"value":"1590-1874","type":"print"},{"value":"1590-3478","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,30]]},"assertion":[{"value":"7 October 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 November 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Our study had the approval of the ethical committee of Ain Shams University, and the ethical reference number is (FMASU: MD 88\/2019). All methods of our trial were performed in accordance with the guidelines and regulations of the Faculty of Medicine Ain Shams University (FMASU), which is organized and operated according to the guidelines of the International Council on Harmonization (ICH), Anesthesiology and the Islamic Organization for Medical Service (IOMS), the United States Office for Human Research Protections, and the United States Code of Federal Regulations, and operates under Federal Wide Assurance no (FWA00001785).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Before randomization, formal written informed consent was obtained from the included patients or their first-degree relatives.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publications"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}