Ticagrelor is not recommended over aspirin for treatment of patients with minor acute stroke. III: No Benefit B-R New recommendation. The recently completed SOCRATES trial (Acute Stroke or Transient Ischaemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was a randomized, double-blind, placebo-controlled trial of ticagrelor versus aspirin begun within 24 hours in patients with minor stroke (NIHSS score 5) or TIA (ABCD2 score 4). With a primary outcome of time to the composite end point of stroke, MI, or death up to 90 days, ticagrelor was not found to be superior to aspirin However, because there were no significant safety differences in the 2 groups, ticagrelor may be a reasonable alternative in stroke patients who have a contraindication to aspirin. See Table XLVIII in online Data Supplement 1. The administration of the IV glycoprotein IIb/IIIa inhibitor abciximab as medical treatment for AIS is potentially harmful and should not be performed. III: Harm B-R Recommendation revised from 2013 AIS Guidelines. A recent Cochrane review of IV glycoprotein IIb/IIIa receptor antagonists in the treatment of AIS found that these agents are associated with a significant risk of ICH without a measurable improvement in death or disability.220 The majority of trial data apply to abciximab, which was studied in the AbESTT trial (A Study of Effectiveness and Safety of Abciximab in Patients With Acute Ischemic Stroke). The phase III trial was terminated early because of an unfavorable risk-benefit analysis.221 See Table XLVIII in online Data Supplement 1. Aspirin is not recommended as a substitute for acute stroke treatment in patients who are otherwise eligible for IV alteplase or mechanical thrombectomy. III: Harm B-R Recommendation revised from 2013 AIS Guidelines. 