Brilinta Plus Aspirin Decrease Stroke Risk, But Increase Risk Of Bleeding: Study

The findings of a new study indicate that stroke patients who took Brilinta with aspirin had a lowered risk of having a repeat stroke within 30 days, but may face a higher risk of suffering a severe bleeding injury.

Researchers with the University of Texas published a study this week in the New England Journal of Medicine, indicating that side effects of Brilinta, combined with aspirin, lowers the risk of suffering a stroke or death within 30 days of another stroke. However, it also found that 1-in-200 Brilinta users may suffer severe bleeding events.

Brilinta (ticagrelor) is a blood thinner used to reduce the risk of cardiovascular death, heart attacks and strokes in patients with acute coronary syndrome (ACS), or by those with history of heart attacks. Brilinta is also commonly used to reduce the rate of stent thrombosis in patients who have received stents for treatment of ACS.

Researchers conducted a randomized controlled, double blind trail with patients who had mild-to-moderate acute noncardioembolic ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score of 5 or less or who had a transient ischemic attack (TIA), but were not undergoing thrombolysis or thrombectomy.

Patients were assigned within 24 hours after symptom onset, with half to receive a 30-day regimen of either Brillinta at 180 mg loading dose followed by 90 mg twice daily plus aspirin at 300 to 325 mg on the first day, followed by 75 to 100 mg daily. The other half were assigned a matching placebo plus aspirin.

More than 11,000 patients were included in the randomized clinical trial. Ischemic stroke occurred in 276 patients, or 5% of patients in the Brillinta-aspirin group. That compares to 345 patients, or 6%, of patients in the placebo-aspirin group had an ischemic stroke.

According to the findings, patients who took the Brillinta-aspirin combo had a lower risk of ischemic stroke. The incidence of disability did not differ significantly between the two groups.

Severe bleeding, however, occurred in 28 patients, or 0.5%, in the Brillinta-aspirin group. Comparatively, severe bleeding occurred in 7 patients, or 0.1%, in the aspirin  only group.

Other studies have indicated taking Brillinta with aspirin did not reduce the risk of stroke, but instead increased the risk of serious bleeding. Another study published in 2016 indicated patients taking Brillinta before heart surgery faced an increased risk of up to 20% for bleeding events.

“Among patients with a mild-to-moderate acute noncardioembolic ischemic stroke or TIA who were not undergoing intravenous or endovascular thrombolysis, the risk of the composite of stroke or death within 30 days was lower with ticagrelor–aspirin than with aspirin alone, but the incidence of disability did not differ significantly between the two groups,” wrote study authors. “Severe bleeding was more frequent with ticagrelor.”