Discussion
pulmonary embolism, death, hemorrhagic, ischemic stroke, neurotoxic
PULMONARY EMBOLISM, HEMORRHAGIC INFARCTION, ISCHEMIC STROKE, SECONDARY, BLIND, COMPLICATIONS
There is an increasing need for new antiplatelets with better efficacy in managing ischemic stroke patients, especially those who do not fit rt-PA therapy secondary to its relatively short window (4.5 h of symptom onset) and its relatively high price and low accessibility, especially in developing countries. [Regarding the current clinical trial’s primary endpoint, there was no statistically significant difference between the two groups regarding hemorrhagic complications. This result agrees with the results of Johnston and colleagues (2016), Wang and colleagues (2017), and Amarenco and colleagues (2017), who found that there was no statistically significant difference between ticagrelor and aspirin as regards hemorrhagic infarction [Concerning our secondary endpoint, we found that patients who received ticagrelor showed statistically significant clinical improvement regarding NIHSS score after 2 days and 1 week of discharge and more favorable mRS scores after 1 week of discharge and after 90 days compared with patients who received aspirin.Even though there has been no such study that compared the outcome of ischemic stroke in patients receiving, loading ticagrelor, or loading aspirin within the first 9 h of onset, our results can be partially in agreement with Wang and colleagues (2017), Amarenco and colleagues (2017), and Johnston and colleagues (2020), who found that patients who received ticagrelor had better clinical outcomes than those receiving aspirin results [Our results may be that ticagrelor is a potent P2Y12 adenosine diphosphate platelet receptor inhibitor that decreases platelet activation in the acute phase of ischemic stroke, which prevents the release of neurotoxic and thrombogenic eicosanoids, including thromboxane B2, and, as a result, it might reduce early death and improve outcomes in survivors by reducing the volume of brain penumbra and reducing the risk of early recurrent ischemic stroke and pulmonary embolism Van Kotte and colleagues (1994) and Wallentin and colleagues (2009) [Although our results were encouraging, our pilot study has some limitations: first, the sample was intended to establish the feasibility of a larger-scale trial powered for both safety and efficacy, and this nature of the sample limits the validity and generalizability of the result; second, patients were not blind to the treatment they received.