Summary
Ticagrelor has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Stroke (Ischaemic / Cerebrovascular Disease) would be drug repurposing rather than first-in-human development. This does not mean it is approved for Stroke (Ischaemic / Cerebrovascular Disease). ClinicalTrials.gov lists 8 registered trials linking Ticagrelor to Stroke (Ischaemic / Cerebrovascular Disease): 3 are currently recruiting; 1 is active or not yet recruiting; 4 have completed. The most advanced is Phase 4 (NCT04962451). The largest enrolment is 665533 participants (NCT01947959). Registration activity spans 2011 to 2025. The literature layer holds 13 publications for this pair: 5 Cochrane reviews, 2 meta-analyses, 1 systematic review and 5 clinical trial publications. Publication years run from 2025 to 2026. Because at least one synthesis-level source exists (systematic review, meta-analysis or Cochrane review), this pair has been assessed beyond single studies, although the synthesis may concern a different indication.
The RepurpOS disease-intelligence file for Ischemic Stroke ranks 577 candidate therapeutics from Open Targets, ChEMBL, DGIdb and PubMed; only a minority carry direct clinical evidence, and this page covers one of those. Spontaneous remission context recorded for the condition: Spontaneous early neurological improvement in 10-20% within 24 hours of ischaemic stroke without intervention; functional independence at 3 months in only 40-50% without revascularisation; 15% 30-day mortality untreated.
Evidence table
| Evidence tier | A · Strong |
|---|---|
| Evidence score | 80.0 (trials 30.0, literature 30.0, tier 15, approved bonus 5.0) |
| Registered trials | 8 total: 3 recruiting, 1 active / not yet recruiting, 4 completed, 0 other |
| Linked publications | 13 (5 Cochrane reviews, 5 clinical trial publications, 2 meta-analyses, 1 systematic review) |
| Agent type | Drug (Small molecule) |
| Development stage (any indication) | Approved |
| Mechanism / class | Not recorded |
| Data sources | Open Targets, ChEMBL |
How the evidence score is calculated
- Each registered trial scores by status (recruiting / active / enrolling 3, completed 2.5, not yet recruiting 2, unknown 1, terminated / withdrawn / suspended 0.5) plus a phase bonus (phase 3-4 +2, phase 2 +1, phase 1 +0.5). The trial component is capped at 30.
- Each literature item scores by design (Cochrane review 5, meta-analysis 4, systematic review 3, RCT 3, clinical trial publication 2, curated reference 1.5, other PubMed record 1). The literature component is capped at 30.
- The existing evidence tier adds 15 (A / Strong), 10 (B / Moderate), 5 (C / Preliminary) or 0 (D / Anecdotal).
- Agents approved for any indication (max clinical phase 4) add 5, because an approved agent has an established safety profile that lowers the barrier to repurposing trials.
- The score ranks what has been studied, not what works. It does not read effect sizes or directions of effect.
Registered clinical trials
| NCT ID | Title | Status | Phase | Enrolment |
|---|---|---|---|---|
| NCT04962451 | Comparison of the Efficacy of Ticagrelor Combined With ASA to ASA Alone in Patients With Stroke 2017 | completed | Phase 4 | 13,000 |
| NCT06316570 | Ticagrelor With Aspirin Dual Antiplatelet Therapy Combined With Intravenous Thrombolysis for Ischemic Stroke 2024 | completed | Phase 3 | 1,382 |
| NCT04738097 | Efficacy of Ticagrelor Plus Aspirin in Mild Non-cardioembolic Ischemic Stroke 2021 | completed | Phase 3 | 90 |
| NCT06591377 | Combining Aspirin With Ticagrelor or Cilostazol in Large-vessel Minor Stroke or TIA 2024 | recruiting | Phase 3 | 900 |
| NCT06196047 | Ticagrelor Versus Cilostazol in Minor Ischemic Stroke or TIA 2023 | recruiting | Phase 3 | 900 |
| NCT06853535 | Precision Antiplatelet Therapy Guided by Platelet Aggregation Function in Patients With Acute Ischemic STROKE 2025 | recruiting | Phase 3 | 5,138 |
| NCT01947959 | Study of Rivaroxaban Use and Potential Adverse Outcomes in Routine Clinical Practice (Germany) 2011 | completed | Not applicable | 665,533 |
| NCT06683300 | Drug Eluting Stenting and Short Dual Antiplatelet Therapy for Preventing Recurrent Stroke in Vertebral Stenosis Registry Study 2024 | not yet recruiting | Not applicable | 520 |
Published literature
- Clinical trial publication Ticagrelor with aspirin dual antiplatelet therapy combined with intravenous thrombolysis in patients with ischaemic stroke in China (TAPIS): a multicentre, double-blind, randomised controlled trialWang A, Xia X, Tang Y et al. · Lancet (London, England) · 2026 · PMID 42114550
- Clinical trial publication Effect of insulin resistance on ticagrelor-versus clopidogrel-based dual antiplatelet therapy for secondary prevention of stroke in carriers of CYP2C19 loss-of-function mutationsZhao J, Tian X, Yang X et al. · CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026 · PMID 41554550
- Clinical trial publication Lp-PLA2 Activity and Genotype-Guided Dual Antiplatelet Therapy in Minor Stroke or Transient Ischemic AttackLin J, Zhou H, Wang Y et al. · Stroke · 2026 · PMID 41527826
- Clinical trial publication Differential Effect of Ticagrelor Versus Clopidogrel by Causative Classification of Stroke Classification and Vascular Cellular Adhesion Molecule-1 Level on the Risk of Recurrent Stroke: A Post Hoc Analysis of the CHANCE-2 TrialLi H, Xia X, Xu Q et al. · Journal of the American Heart Association · 2026 · PMID 41413755
- Clinical trial publication Genotype-guided dual antiplatelet therapy in minor stroke or transient ischemic attack with metabolic syndrome: A post hoc analysis of CHANCE-2Feng Z, Zhang F, Jin A et al. · Diabetes, obesity & metabolism · 2026 · PMID 41145384
- Cochrane review Optimal duration of dual antiplatelet therapy for secondary stroke prevention: A systematic review and meta-analysisOliveira Filho ARDS, de Oliveira Souza NV, Oliveira DM et al. · Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2026 · PMID 42218849
- Cochrane review Impact of dual antiplatelet therapy within 72 hours post mild ischemic stroke and transient ischemic attack: meta-analysisXie J · Brain injury · 2026 · PMID 41251253
- Meta-analysis Safety and efficacy of ticagrelor plus aspirin vs. aspirin monotherapy in patients undergoing coronary artery bypass grafting: A meta-analysis with trial sequential analysisHammadeh BM, Hussein AM, Alhamwi N et al. · Journal of thrombosis and thrombolysis · 2026 · PMID 41917648
- Systematic review Interaction of CYP2C19 with the effect of clopidogrel in secondary prevention of major ischemic events: Systematic review and meta-analysisKremers FC, van den Biggelaar J, Lingsma HF et al. · International journal of stroke : official journal of the International Stroke Society · 2026 · PMID 40844153
- Cochrane review Effectiveness and safety of different antiplatelet therapies for minor ischemic stroke or high-risk transient ischemic attack: a systematic review and network meta-analysisJin T, Jiang H, Chen G et al. · International journal of clinical pharmacy · 2025 · PMID 41118059
- Cochrane review Comparative efficacy and safety of different durations of dual antiplatelet therapy in acute minor non-cardioembolic stroke: a systematic review and network meta-analysisLiu W, Luo S, Huang R et al. · Journal of neurology · 2025 · PMID 40550925
- Cochrane review Antiplatelet versus anticoagulation treatment for people with heart failure in sinus rhythmKozieł-Siołkowska M, Shantsila E, Shantsila A et al. · The Cochrane database of systematic reviews · 2025 · PMID 40497467
- Meta-analysis Genotype-guided ticagrelor/prasugrel versus clopidogrel therapy in stroke patients with CYP2C19 loss of function alleles: a systematic review and meta-analysisBiswas M, Murad MA, Ershadian M et al. · Pharmacogenomics · 2025 · PMID 41450128
Mechanism and notes
No mechanism of action is recorded for this pair in the source databases.
OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in Open Targets and ChEMBL. The tier describes how well the drug-disease link is documented, not how well the drug works.
Frequently asked questions
Is Ticagrelor approved for Stroke (Ischaemic / Cerebrovascular Disease)?
Ticagrelor has reached the approved stage (maximum clinical phase 4) for at least one indication, so its use in Stroke (Ischaemic / Cerebrovascular Disease) would be drug repurposing rather than first-in-human development. This does not mean it is approved for Stroke (Ischaemic / Cerebrovascular Disease). Approval status for the specific indication should always be confirmed with the relevant regulator and prescribing information.
Is Ticagrelor in clinical trials for Stroke (Ischaemic / Cerebrovascular Disease)?
ClinicalTrials.gov lists 8 registered trials linking Ticagrelor to Stroke (Ischaemic / Cerebrovascular Disease): 3 are currently recruiting; 1 is active or not yet recruiting; 4 have completed. The most advanced is Phase 4 (NCT04962451). The largest enrolment is 665533 participants (NCT01947959). Registration activity spans 2011 to 2025.
What does the evidence show for Ticagrelor in Stroke (Ischaemic / Cerebrovascular Disease)?
Ticagrelor has both completed registered trials and synthesis-level publications linked to Stroke (Ischaemic / Cerebrovascular Disease). That is the strongest profile in this database, but the summaries here do not extract effect sizes, so read the linked reviews for direction and magnitude of benefit. OSMF's existing evidence tier for this pair is A (Strong), derived from the strength of the disease association recorded in Open Targets and ChEMBL. The tier describes how well the drug-disease link is documented, not how well the drug works.
Cite this page
Data: ClinicalTrials.gov, PubMed, Open Targets, ChEMBL, DGIdb and the OSMF therapeutic agent database. Last updated 2026-07-05. Page built 2026-10-07.