{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:55:33Z","timestamp":1787810133744,"version":"build-2784847793"},"reference-count":38,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>More intensive antiplatelet agents may reduce recurrent stroke risk in minor stroke and TIA, particularly those with non-cardioembolic stroke. The SOCRATES trial showed that ticagrelor was not superior to aspirin in decreasing the risk of stroke, heart attack, or death at 90\u2009days in patients with minor ischemic stroke or TIA. Cilostazol has been shown to have similar effects on platelet reactivity and aggregation to those produced by ticlopidine and aspirin, but may be associated with fewer hemorrhagic side effects. It is also cheaper than ticagrelor; for example, it is approximately half that of ticagrelor, making it a potentially cost-effective antiplatelet agent, especially in low and middle-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To evaluate the benefits or hazards of adding cilostazol or ticagrelor to aspirin in patients with minor ischemic stroke or TIA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We randomized 900 first-ever, large-vessel occlusion minor ischemic stroke or TIA patients in a one-to-one ratio to receive either a 200\u2009mg loading dose of cilostazol within 24 h after acute stroke symptoms, then 100\u2009mg twice daily until day 90 post-stroke, or a 180\u2009mg loading dose of ticagrelor during the first 24 h, followed by 90\u2009mg twice daily from day 2 to day 90. Both groups received an open-label 300\u2009mg loading dose of aspirin during the first 24 h, then 75\u2009mg once daily. We followed up with our patients for 3 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      857 patients completed the 3-month follow-up study 34 (7.6%) patients in the cilostazol group and 29 (6.4%) patients in the ticagrelor group experienced a new stroke (either hemorrhagic or ischemic) (HR 1.37; 95% CI, 0.84\u20132.26;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      -value\u2009=\u20090.21), and 44 (9.8%) patients in the cilostazol group and 40 (8.9%) patients in the ticagrelor group experienced a composite of a new stroke, myocardial infarction (MI), or death due to vascular insults (HR 1.11; 95% CI, 0.64\u20131.93;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      -value\u2009=\u20090.30). Fifteen (3.3%) patients in the cilostazol arm and 30 (6.7%) patients in the ticagrelor arm experienced drug-related hemorrhagic complications (HR 0.32; 95% CI, 0.19\u20130.68;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      -value\u2009=\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Combining cilostazol with aspirin in large-vessel occlusion 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930251406865","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:34:37Z","timestamp":1764678877000},"page":"1019-1029","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1177","volume":"21","author":[{"given":"Mohamed","family":"Ismaiel","sequence":"first","affiliation":[{"name":"Neurology Department, Al-Sahel Teaching Hospital, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherihan Rezk","family":"ahmed","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Fouad Elsayed","family":"Khalil","sequence":"additional","affiliation":[{"name":"Neurology Department, NMC Royal Hospital MBZ, Abu Dhabi, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Galal","family":"Elmesallami","sequence":"additional","affiliation":[{"name":"Neurology Department, Khoula Hospital, Muscat, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed ahmed Mohamed kamal","family":"ebied","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Zaki Omar","family":"Akl","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssry salah shafiq","family":"kerolos","sequence":"additional","affiliation":[{"name":"Neurology Department, Saudi German Hospital, Dubai, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"elshafei","sequence":"additional","affiliation":[{"name":"Neurology Department, Zulekha Hospital, Dubai, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enji Hamdy elsawy","family":"Khalil","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mohamed ali","family":"Daabis","sequence":"additional","affiliation":[{"name":"Neurology Department, Burjeel Royal Hospital, Al Ain, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romany Adly","family":"Yousef","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurointervention, El-Mataria Teaching Hospital, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalia maher","family":"samy","sequence":"additional","affiliation":[{"name":"Neurology Department, Al-Sahel Teaching Hospital, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamada","family":"Zehry","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Horus University-Egypt, New Damietta, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf Ali","family":"Soliman","sequence":"additional","affiliation":[{"name":"Neurology Department, Burjeel Medical City, Abu Dhabi, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghada Abd Elwahab","family":"Khalil Ibrahim","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0337-349X","authenticated-orcid":false,"given":"Mohamed G.","family":"Zeinhom","sequence":"additional","affiliation":[{"name":"Neurology Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2024-003293"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-024-01080-5"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/jscd.2000.7216"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.5551\/jat.63632"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-024-01127-7"},{"key":"e_1_3_3_7_2","article-title":"Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial","volume":"365","author":"Wang Y","year":"2019","unstructured":"Wang Y, Chen W, Lin Y, et al. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. BMJ 2019; 365: l2211.","journal-title":"BMJ"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000418"},{"key":"e_1_3_3_9_2","first-page":"1","volume-title":"Assessing stroke\u2014scores & scales","author":"Julie Fussner CV","year":"2019","unstructured":"Julie Fussner CV. Assessing stroke\u2014scores & scales. Dallas, TX: American Stroke Association, 2019, pp.1\u201323."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-019-1010-x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.108.192218"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.53.1.126"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000211"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.23924"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.003284"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(13)70310-7"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.030509"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.035002"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001972"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000018645.04200.7D"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.123.031611"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1916870"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603060"},{"key":"e_1_3_3_25_2","first-page":"215","article-title":"Pharmacological manipulation of tissue cyclic AMP by inhibitors","volume":"25","author":"Tani T","year":"1992","unstructured":"Tani T, Sakurai K, Kimura Y, Ishikawa T, Hidaka H. Pharmacological manipulation of tissue cyclic AMP by inhibitors. Adv Second Messenger Phosphoprotein Res 1992; 25: 215\u2013227.","journal-title":"Adv Second Messenger Phosphoprotein Res"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-29423-5_9"},{"key":"e_1_3_3_27_2","doi-asserted-by":"crossref","unstructured":"Zeinhom MG Ismaiel M Khalil MFE et al. CILO-CLOP trial: cilostazol versus clopidogrel in acute moderate and moderate-to-severe ischemic stroke: a randomized controlled multicenter trial. Neurol Ther 2025; 14: 927\u2013948. https:\/\/link.springer.com\/10.1007\/s40120-025-00739-5","DOI":"10.1007\/s40120-025-00739-5"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-025-08107-9"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873211000877"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111749"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000174189.81153.85"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-76189-0"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.609370"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/2040622320936418"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-023-03522-3"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosissup.2005.09.002"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(03)01029-2"},{"key":"e_1_3_3_38_2","first-page":"269","article-title":"Comparison of the effects of acetylsalicylic acid, ticlopidine and cilostazol on primary hemostasis using a quantitative bleeding time test apparatus","volume":"29","author":"Tamai Y","year":"1999","unstructured":"Tamai Y, Takami H, Nakahata R, Ono F, Munakata A. Comparison of the effects of acetylsalicylic acid, ticlopidine and cilostazol on primary hemostasis using a quantitative bleeding time test apparatus. Haemostasis 1999; 29: 269\u2013276.","journal-title":"Haemostasis"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1500857"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930251406865","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17474930251406865","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930251406865","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T13:59:37Z","timestamp":1784815177000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17474930251406865"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,23]]},"references-count":38,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/17474930251406865"],"URL":"https:\/\/doi.org\/10.1177\/17474930251406865","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,23]]}}}