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Ischemic StrokePhase 3NCT06591377

Combining Aspirin With Ticagrelor or Cilostazol in Large-vessel Minor Stroke or TIA

A Phase 3 study testing Ticagrelor 90 MG, Cilostazol 100 MG and Aspirin 75mg in people with Ischemic Stroke, run by Kafrelsheikh University at 2 sites in Egypt.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Along with the current clinical trial, the efficacy and safety of a 180 mg loading dose of ticagrelor administered within 24 hours of the first-ever large-vessel minor stroke or TIA compared to 200mg cilostazol were assessed through NIHSS, mRS, and possible adverse effects. Read more about this study

Who is it for?
Ages 18 to 75 years
Conditions the study is for
Ischemic Stroke
What is being tested?
Ticagrelor 90 MG, Cilostazol 100 MG and Aspirin 75mg
Could I receive a placebo?
No, everyone receives an active treatment
How many people
900 participants
Where
2 sitesEgypt
Study dates
10 Aug 2024to 1 Oct 2025
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • the investigators included both genders with eligible ages ranging between 18-75 years, with the first-ever presentation with large-vessel minor ischemic stroke or TIA who received antiplatelet treatment within the first 24 hours of the onset of ischemic stroke. Patients are not eligible for rt-PA treatment

Who cannot join

  • The investigators excluded patients who had not been followed up on for 90 days after enrollment, those with NIHSS < 5 or who had rapidly resolving symptoms before imaging results, and patients with a known history of persistent or recurrent CNS pathology (e.g., epilepsy, meningioma, multiple sclerosis, history of head trauma with a residual neurological deficit).
  • The investigators excluded patients who had clinical seizures at the onset of their stroke, as well as those who had symptoms of any major organ failure, active malignancies, or an acute myocardial infarction within the previous six weeks, and those who were on warfarin, regular ticagrelor during the week before admission, or chemotherapy within the previous year.
  • The investigators excluded patients with active peptic ulcers, GIT surgery, bleeding history within the last year, and those with a history of major surgery within the last three months.
  • The investigators ruled out our trial patients who had a known allergy to the study drugs and those with INR > 1.4 or P.T. >18 or blood glucose level < 50 or > 400 mg/DL or blood pressure < 90/60 or > 185/110 mmHg on admission or Platelets < 100,000.
  • The investigators excluded pregnant and lactating patients and those with stroke due to venous thrombosis and stroke following cardiac arrest or profuse hypotension ineligible for our trial.
  • Patients with contraindications to the study drugs were excluded.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

mohamed G. Zeinhom, MD contact

2001009606828

mohamed_gomaa@med.kfs.edu.eg

sherihan R. ahmed, MD contact

2001113432342

sherihan_rezq@med.kfs.edu.eg

Egypt2 sites, 2 recruiting
  • El-sahel teaching hospital

    Cairo, 22514

    Mohamed Ismaiel, MSc, 201125046663, elkashefneuro@gmail.com

    Mohamed Ismaiel, MSc

    Recruiting
  • Kafr Elsheikh University Hospital

    Kafr ash Shaykh, 33511

    mohamed G. Zeinhom, MD, 2001009606828, mohamed_gomaa@med.kfs.edu.eg

    sherihan R. ahmed, MD, 2001007481842, sherihan_rezq@med.kfs.edu.eg

    Recruiting

Other trials in Egypt

About this study

Official title: Combining Aspirin With Ticagrelor or Cilostazol in Large-vessel Minor Stroke or TIA, a Randomized Controlled Trial

Along with the current clinical trial, the efficacy and safety of a 180 mg loading dose of ticagrelor administered within 24 hours of the first-ever large-vessel minor stroke or TIA compared to 200mg cilostazol were assessed through NIHSS, mRS, and possible adverse effects.

Read the detailed description

The investigators conducted a single-blinded randomized controlled trial after the ethics committee of the faculty of medicine at Kafr el-Sheik University approved it.

The investigators got written informed consent from all eligible patients or their first order of kin before randomization.

The study will be composed of 2 arms ticagrelor arm, which consisted of 450 patients who received a 180mg loading dose followed by 90 mg twice daily from the 2nd to the 90th day), and the cilostazol arm, consisting of 450 patients who received (a 200mg loading dose during the first 24 hours of stroke onset followed by 100mg twice daily from the 2nd day to the 90th day),

Study Procedures:

Every patient in our study will undergo:

Clinical workup: History, clinical assessment \& NIHSS were recorded on admission, day 7, and the Modified Rankin Scale as a follow-up after one week and 3 months.

Detection of Risk Factors \& Profiles:

Echocardiography TTE: in indicated patients ECG Monitoring: daily ECG monitoring will be performed in indicated patients. 3- Carotid Duplex: carotid duplex in indicated patients.

4- ESR \& Lipid Profile\& liver functions: All will be tested routinely for all patients.

Imaging Follow-UP Non-contrast CT brain on admission Day 2 MRI: after two days of admission, all the patients in this study will have a brain MRI (stroke protocol; T1W, T2W, FLAIR, DWI, T2 Echo Gradient, MRA of all intra-cerebral vessels).

CT brain: Any patient with unexplained clinical deterioration at any time throughout his/her hospital stay will be urgently imaged by CT.

Primary End Point:

The primary efficacy outcome was the rate of new stroke at 90 days, and the primary safety outcome was the rate of drug hemorrhagic complications using the PLATO bleeding definition.

  • Secondary End Point: The secondary efficacy outcomes were to evaluate the rates of patients who achieved a significant reduction in NIHSS (decrease of four points or more) at the seventh day or discharge compared to baseline, the rates of a favorable outcome with (mRS = 0-2) after one week and after 90 days in a face-to-face interview in the outpatient clinic, rates of a composite of recurrent stroke, myocardial infarction and death due to vascular events after 90 days of follow-up, while the secondary safety outcome was the rate of treatment-related adverse effects assessed by a follow-up questionnaire
Conditions
Ischemic Stroke
Being tested
Ticagrelor 90 MG, Cilostazol 100 MG, Aspirin 75mg
Keywords
cilostazol, ticagrlor, large-vessel stroke
Medical subject headings
Ischemic Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ticagrelor 90 MGDrug

    Also called group A

    The ticagrelor arm will receive (a 180mg loading dose of cilostazol during the first 24 hours of stroke onset, followed by 90mg once daily from the 2nd day to the 90th day) and an open-label loading 300 mg aspirin, followed by a maintenance dose of 75 mg aspirin

  • Cilostazol 100 MGDrug

    Also called group B

    The cilostazol arm will receive (a 200 mg loading dose of clopidogrel during the first 24 hours of stroke onset, followed by 100 mg twice daily from the 2nd day to the 90th day) and open-label loading 300 mg aspirin, followed by a maintenance dose of 75 mg aspirin.

  • Aspirin 75mgDrug

    Also called group A

    The ticagrelor arm will receive (a 180mg loading dose of cilostazol during the first 24 hours of stroke onset, followed by 90mg once daily from the 2nd day to the 90th day) and an open-label loading 300 mg aspirin, followed by a maintenance dose of 75 mg aspirin

  • Aspirin 75mgDrug

    Also called group B

    The cilostazol arm will receive (a 200 mg loading dose of clopidogrel during the first 24 hours of stroke onset, followed by 100 mg twice daily from the 2nd day to the 90th day) and open-label loading 300 mg aspirin, followed by a maintenance dose of 75 mg aspirin.

Study groups in NCT06591377
Study groupRoleWhat they receive
Ticagrelor and aspirin armActive comparatorThe ticagrelor arm will receive (a 180 mg loading dose of cilostazol during the first 24 hours of stroke onset, followed by 90 mg twice daily from the 2nd day to the 90th day) and an open-label loading 300 mg aspirin, followed by a maintenance dose of 75 mg aspirin.
Receives: Drug: Ticagrelor 90 MG; Drug: Aspirin 75mg
cilostazol and aspirinActive comparatorThe cilostazol arm will receive (a 200 mg loading dose of cilostazol during the first 24 hours of stroke onset, followed by 100 mg twice daily from the 2nd day to the 90th day) and open-label loading 300 mg aspirin, followed by a maintenance dose of 75 mg aspirin.
Receives: Drug: Cilostazol 100 MG; Drug: Aspirin 75mg

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. rate of new stroke

    Rates of new stroke occur within three months of treatment. The investigators will perform follow-ups of the patient during visits to the outpatient clinic, and brain CT and/ or MRI will be done if there is suspicion of a new stroke.

    Measured: 90 days

  2. Rate of drug-related hemorrhagic complications

    the rate of drug hemorrhagic complications which was evaluated using the PLATO bleeding definition which classified hemorrhagic complications into three types as follows: Major bleeding which had one or more of the following criteria: fatal bleeding, intracranial, intrapericardial, bleeding associated with reduction of hemoglobin > 3-5 g/dl, bleeding required transfusion of two to four units whole blood or PRBCs, bleeding produced hypovolemic shock or severe hypotension that required pressor or surgery; Minor bleeding that required medical intervention to stop or treat bleeding: Minimal bleeding: any bleeding that did not require intervention or treatment such as bruising, bleeding gums, oozing from injection sites.

    Measured: 90 days

Secondary outcomes (3)
  1. value of Modified Rankin Scale(mRS) at three months

    mRS Measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability; its value ranges from 0 to 6; the lower the score, the better the stroke outcome. A favorable stroke outcome is considered with mRS value equal to two or less.

    Measured: 3 months

  2. rate of composite recurrent stroke, myocardial infarction, and death due to vascular events

    Rates of new stroke, TIA, myocardial infarction, or death from vascular events within three months of treatment, the investigators will perform follow-ups of the patient during visits to the outpatient clinic and perform needed investigations such as brain imaging, Electrocardiography, arterial and venous duplex ultrasound imaging.

    Measured: 3 months

  3. rate of drug adverse effects

    all side effects related to the medications of our study will be reported

    Measured: 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Sep 2024
  2. Study start10 Aug 2024
  3. Primary completion19 Sep 2025 (estimated)
  4. Study completion1 Oct 2025 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
The investigators will conduct our single-blinded randomized controlled trial, which will contain two arms; the cilostazol arm will receive (a 200 mg loading dose during the first 24 hours of stroke onset, followed by 100 mg twice daily from the 2nd to the 90th day). The ticagrelor arm will receive (a 180 mg loading dose during the first 24 hours of stroke onset, followed by 90 mg twice daily from the 2nd to the 90th day). Both groups received an open-label loading dose of 300 mg aspirin and continued on open-label aspirin 75 mg daily.
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
900 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06591377
Sponsor's protocol ID
2309881671459145
Status last verified
Sep 2025
First submitted
8 Sep 2024
Last updated
18 Sep 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: All the data that support the findings of this research will be available from the corresponding author M. Zeinhom upon reasonable request.

Publications

  • Paciaroni M, Ince B, Hu B, Jeng JS, Kutluk K, Liu L, Lou M, Parfenov V, Wong KSL, Zamani B, Paek D, Min Han J, Del Aguila M, Girotra S. Benefits and Risks of Clopidogrel vs. Aspirin Monotherapy after Recent Ischemic Stroke: A Systematic Review and Meta-Analysis. Cardiovasc Ther. 2019 Dec 1;2019:1607181. doi: 10.1155/2019/1607181. eCollection 2019.

    PubMed 31867054
  • Lipton RB, Liberman JN, Kolodner KB, Bigal ME, Dowson A, Stewart WF. Migraine headache disability and health-related quality-of-life: a population-based case-control study from England. Cephalalgia. 2003 Jul;23(6):441-50. doi: 10.1046/j.1468-2982.2003.00546.x.

    PubMed 12807523

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Ticagrelor 90 MG, Cilostazol 100 MG and Aspirin 75mg in people with Ischemic Stroke, run by Kafrelsheikh University at 2 sites in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 18 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact mohamed G. Zeinhom, MD (2001009606828, mohamed_gomaa@med.kfs.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

rate of new stroke (time frame: 90 days). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06591377, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Sep 2025; AzTrials last refreshed its copy on 7 Nov 2026.

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