COMPARISON OF ASPIRIN AND TICAGRELOR VERSUS ASPIRIN AND CLOPIDOGREL IN SECONDARY PREVENTION OF STROKE/ TRANSIENT ISCHEMIC ATTACK AMONG PATIENTS WITH ACUTE MINOR ISCHEMIC STROKE/ HIGH RISK TRANSIENT ISCHEMIC ATTACK-A RANDOMIZED CONTROL TRIAL

This randomized controlled trial titled Comparison of Aspirin and Ticagrelor versus Aspirin and Clopidogrel in Secondary Prevention of Stroke or Transient Ischemic Attack among Patients with Acute Minor Ischemic Stroke High Risk Transient Ischemic Attack aims to evaluate the comparative efficacy of two dual antiplatelet regimens in preventing recurrent cerebrovascular events. Conducted at the Pondicherry Institute of Medical Sciences from July 2025 to June 2027 the study will enroll 70 patients aged 18 years or older presenting within 72 hours of a minor ischemic stroke NIHSS less than or equal to 7 or high risk TIA ABCD2 greater than or equal to 4. Participants will be randomized equally to receive either aspirin plus ticagrelor or aspirin plus clopidogrel for 21 days followed by aspirin monotherapy. The primary outcome is the incidence of recurrent stroke or TIA within 90 days while secondary outcomes include functional outcomes major adverse cardiovascular events and major bleeding. Data analysis will be performed using SPSS with statistical significance set at p less than 0.05. The study hypothesizes that aspirin plus ticagrelor will provide superior protection against recurrent ischemic events especially relevant for the Indian population with a high prevalence of CYP2C19 loss of function alleles that may reduce clopidogrel efficacy. Ethical clearance has been obtained and informed consent will be secured from all participants. The findings are expected to guide optimization of dual antiplatelet therapy for secondary stroke prevention in the Indian context.