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May 8, 2026European Stroke Journal0 citationsOpen Access

Tailored Antiplatelet Strategy for Non-Cardioembolic Ischemic Stroke

Abstract Number: Esoc2026a1846 Tailored Antiplatelet Secondary Prevention in Non-Cardioembolic Ischemic Stroke: A Phase Iv Gender-Stratified Randomized Controlled Trial (Tailor Trial) – Study Design

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Why the study?

Many patients have biological non-responsiveness to antiplatelet agents, increasing early recurrence risk, but whether a tailored, platelet function-guided strategy improves short-term outcomes versus usual care in non-cardioembolic ischaemic stroke is unknown.

Does a tailored, platelet function-guided antiplatelet strategy reduce the composite of recurrent ischaemic stroke, myocardial infarction, or cardiovascular death in patients with recent non-cardioembolic ischaemic stroke compared to usual care?

Population

Patients with recent non-cardioembolic ischaemic stroke requiring secondary antiplatelet prevention across three Italian stroke centres

Comparison

Tailored platelet function-guided antiplatelet strategy vs usual care

Design

Phase IV multicentre pragmatic open-label gender-stratified RCT with blinded endpoint adjudication

Follow-up

3 months

Key result

The TAILOR trial is a planned randomized study designed to evaluate whether a platelet function-guided antiplatelet strategy reduces 3-month cardiovascular events from an assumed 9% to 5%.

Authors

AZAndrea ZiniMPMatteo PaolucciSFStefano Forlivesi

Discussion

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Overview

The TAILOR trial is designed to determine if a precision-medicine approach using platelet function testing to guide antiplatelet therapy reduces early cardiovascular events after non-cardioembolic ischemic stroke.

Key Points

  • Evaluate if a tailored antiplatelet strategy improves outcomes compared to usual care in non-cardioembolic ischemic stroke patients.
  • Phase IV, multicentre, pragmatic, open-label, gender-stratified, randomized controlled trial.
  • Patients with recent non-cardioembolic ischemic stroke are randomized 1:1 to usual care or tailored therapy guided by platelet aggregation testing.
  • Follow-up duration is 3 months with a primary endpoint of cumulative incidence of recurrent events.
  • Trial aims to reduce the primary composite endpoint from 9% (usual care) to 5% (tailored therapy).
  • Interim safety and feasibility analyses planned during recruitment.
  • Final results expected within six months after completion.

Study Design

Type

RCT

Blinding

Open-label

Randomization

1:1

Multicenter

Yes

Structured PICO

Does a tailored, platelet function-guided antiplatelet strategy reduce the composite of recurrent ischaemic stroke, myocardial infarction, or cardiovascular death in patients with recent non-cardioembolic ischaemic stroke compared to usual care?

P
Population
Patients with recent non-cardioembolic ischaemic stroke requiring secondary prevention with antiplatelet therapy
I
Intervention
Tailored antiplatelet strategy guided by platelet aggregation testing (antiplatelet therapy modified in case of non-responsiveness after a 7-10 day run-in period)
C
Comparator
Usual care
O
Outcome
3-month cumulative incidence of a composite of recurrent ischaemic stroke, myocardial infarction, or cardiovascular deathcomposite

The TAILOR trial is designed to determine if a precision-medicine approach using platelet function testing to guide antiplatelet therapy reduces early cardiovascular events after non-cardioembolic ischemic stroke.

Cite This Study

Zini et al. (2026) conducted an RCT in Non-cardioembolic ischaemic stroke. Tailored antiplatelet strategy guided by platelet aggregation testing vs. Usual care was evaluated on 3-month cumulative incidence of a composite of recurrent ischaemic stroke, myocardial infarction, or cardiovascular death. The TAILOR trial is a planned randomized study designed to evaluate whether a platelet function-guided antiplatelet strategy reduces 3-month cardiovascular events from an assumed 9% to 5%.

synapsesocial.com/papers/69fd7ec6bfa21ec5bbf07138https://doi.org/10.1093/esj/aakag023.868
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