{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:46:16Z","timestamp":1791899176086,"version":"4.3.4"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Whether diffusion\u2011weighted imaging infarction patterns influence the efficacy and safety of early oral ticagrelor\u2011aspirin with intravenous thrombolysis in moderate acute ischemic stroke is uncertain. We assessed treatment effects by infarction pattern in this thrombolysis setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This was a subgroup analysis of the TAPIS trial (Ticagrelor With Aspirin Dual Antiplatelet Therapy Combined With Intravenous Thrombolysis in Patients With Ischemic Stroke), a 60-center, randomized, double\u2011blind trial in China. Patients aged 18 to 80 years with noncardioembolic stroke (National Institutes of Health Stroke Scale score 4\u201310) who received intravenous thrombolysis within 4.5 hours of onset were randomized within 6 hours to ticagrelor\u2011aspirin or placebo. Diffusion\u2011weighted imaging patterns were centrally adjudicated as multiple acute infarcts (MAIs; \u22652 lesions) or non\u2011MAIs (single infarction or diffusion\u2011weighted imaging\u2013negative). The primary efficacy outcome was modified Rankin Scale score of 0 to 1 at 90 days; safety outcome was symptomatic intracranial hemorrhage. Treatment\u2011by\u2011pattern interaction was assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 1307 patients (94.6% of full analysis set; median age, 65.5 years; 71.2% men; median National Institutes of Health Stroke Scale score, 6.0), 409 (31.3%) had MAIs and 898 (68.7%) non\u2011MAIs (20.8% diffusion\u2011weighted imaging\u2013negative, 79.2% single infarction). MAIs were associated with poorer prognosis than non\u2011MAIs (excellent outcome: 58.9% versus 69.2%; adjusted risk ratio, 0.92 [95% CI, 0.84\u20131.00]). Ticagrelor\u2011aspirin was associated with a higher likelihood of excellent outcome versus placebo in MAIs (64.4% versus 53.4%; risk ratio, 1.21 [95% CI, 1.02\u20131.42]), whereas no significant benefit was observed in non\u2011MAIs (71.2% versus 67.1%; risk ratio, 1.06 [95% CI, 0.97\u20131.16];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.18). Early neurological improvement showed significant heterogeneity by infarction pattern (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      <jats:sub>interaction<\/jats:sub>\n                      =0.02); the treatment\u2011by\u2011pattern interaction for the primary outcome was nominally significant after adjusting for rescue tirofiban use (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.04). Symptomatic intracranial hemorrhage occurred in MAIs: 1 of 205 (0.5%) versus 2 of 204 (1.0%); non\u2011MAIs: 1 of 448 (0.2%) versus 1 of 450 (0.2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In thrombolyzed patients with moderate noncardioembolic stroke, MAIs were associated with poorer functional outcomes. Early ticagrelor\u2011aspirin showed directionally consistent benefits without excess bleeding in patients with MAIs, though the primary interaction was not significant. These hypothesis\u2011generating findings may inform future trials of diffusion\u2011weighted imaging infarction pattern as an imaging biomarker to guide antiplatelet therapy in early reperfusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT06316570.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.126.057001","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T09:00:18Z","timestamp":1788426018000},"page":"2958-2970","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ticagrelor-Aspirin With Thrombolysis by Infarct Patterns in Moderate Ischemic Stroke: TAPIS Subgroup Analysis"],"prefix":"10.1161","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct06316570","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1713-8535","authenticated-orcid":true,"given":"Xiaohui","family":"Zi","sequence":"first","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"Beijing Tiantan Hospital, Department of Clinical Epidemiology and Clinical Trial (X. Zi, X.X., A.W.), Capital Medical University."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurology, Liuyang Jili Hospital, Changsha, China (Y.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4038-2694","authenticated-orcid":true,"given":"Guojuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Tangshan Gongren Hospital, North China University of Science and Technology (G.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9542-2772","authenticated-orcid":true,"given":"Qinghua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China (Q.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1719-0598","authenticated-orcid":true,"given":"Xue","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"Department of Epidemiology, Beijing Neurosurgical Institute (X.X., J.L., X. Zhang, A.W.), Capital Medical University."},{"name":"Beijing Tiantan Hospital, Department of Clinical Epidemiology and Clinical Trial (X. Zi, X.X., A.W.), Capital Medical University."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9974-6851","authenticated-orcid":true,"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"Department of Epidemiology, Beijing Neurosurgical Institute (X.X., J.L., X. Zhang, A.W.), Capital Medical University."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8986-3119","authenticated-orcid":true,"given":"Xiaoli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"Department of Epidemiology, Beijing Neurosurgical Institute (X.X., J.L., X. Zhang, A.W.), Capital Medical University."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9822-5758","authenticated-orcid":true,"given":"Jing","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2734-5132","authenticated-orcid":true,"given":"Philip M.","family":"Bath","sequence":"additional","affiliation":[{"name":"Stroke Trials Unit, Mental Health &amp; Clinical Neuroscience, University of Nottingham, United Kingdom (P.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5059-4095","authenticated-orcid":true,"given":"Guillaume","family":"Turc","sequence":"additional","affiliation":[{"name":"Department of Neurology, GHU Paris Psychiatrie et Neurosciences, France (G.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4351-2877","authenticated-orcid":true,"given":"Anxin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"Department of Epidemiology, Beijing Neurosurgical Institute (X.X., J.L., X. Zhang, A.W.), Capital Medical University."},{"name":"Beijing Tiantan Hospital, Department of Clinical Epidemiology and Clinical Trial (X. Zi, X.X., A.W.), Capital Medical University."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2725-2788","authenticated-orcid":true,"given":"Yilong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"China National Clinical Research Center for Neurological Diseases (X. Zi, X.X., J.L., X. Zhang, J.J., A.W., Y.W.), Capital Medical University."},{"name":"Advanced Innovation Center for Human Brain Protection (Y.W.), Capital Medical University."},{"name":"Chinese Institute for Brain Research, Beijing (Y.W.)."},{"name":"National Center for Neurological Disorders, Beijing, China (Y.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the TAPIS Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000513"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2024-003977"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2396987321989865"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000170711.43405.81"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.59.6.862"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008395"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.120.032810"},{"key":"e_1_3_3_9_2","first-page":"923","article-title":"Platelet activation by fibrinolytic agents: a potential mechanism for resistance to thrombolysis and reocclusion after successful thrombolysis.","volume":"6","author":"Leopold JA","year":"1995","unstructured":"Leopold JA, Loscalzo J. 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