Ticagrelor vs Clopidogrel in CYP2C19 loss-of-function carriers with Stroke or TIA

BACKGROUNDComparisons between ticagrelor- aspirin and clopidogrel-aspirin in CYP2C19 loss-of-function carriers have not been well studied for secondary stroke prevention.METHODSWe conducted a randomized, double-blind, placebo-controlled trial of 6,412 patients with a minor ischemic stroke or TIA who carried CYP2C19 LOF alleles determined by point-of-care testing. Patients were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio to receive ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or clopidogrel (300 mg loading dose on day 1 followed by 75 mg per day for days 2 through 90), plus aspirin (75-300 mg loading dose followed by 75 mg daily for 21 days). The primary efficacy outcome was stroke and the primary safety outcome was severe or moderate bleeding, both within 90 days. RESULTSStroke occurred within 90 days in 191 (6.0%) versus 243 (7.6%), respectively (hazard ratio, 0.77; 95% confidence interval, 0.64 to 0.94; P=0.008). Moderate or severe bleeding occurred in 9 patients (0.3%) in the ticagrelor-aspirin group and in 11 patients (0.3%) in the clopidogrel-aspirin group; any bleeding event occurred in 170 patients (5.3%) vs 80 (2.5%), respectively. CONCLUSIONSAmong Chinese patients with minor ischemic stroke or TIA within 24 hours after symptoms onset who were carriers of CYP2C19 loss-of-function alleles, ticagrelor- aspirin was modestly better than clopidogrel-aspirin for reducing the risk of stroke but was associated with more total bleeding events at 90 days. (CHANCE-2 ClinicalTrials.gov number, NCT04078737.

A System of Shared Autonomous Vehicles Combined with Park-And-Ride in Residential Areas

As suburbanization and unprecedented population aging are converging, enhanced personal mobility for suburban residents is required. In this study, a collaborative scheme involving park-and-ride services associated with public transport and a shared autonomous vehicle system are proposed. Two residential areas in the Nagoya metropolitan region, Japan, are considered: a residential area at the outer edge of a subway line and a commuter town with a nearby railway station. Three user groups are assumed: park-and-ride commuters who park shared autonomous vehicles at the station and take the train to their workplaces; inbound commuters who disembark from trains at the station and use the vehicles to reach their workplaces within the target area; and elderly and disabled residents, who use shared autonomous vehicles for trips within the target area. The system performance is investigated through agent-based simulation. The results suggest that, in the edge case, approximately 400 shared autonomous vehicles can facilitate more than 10,000 trips at an appropriate level of service. For the commuter town, fewer than 400 vehicles can provide rapid responses with a wait time of approximately 5 min for more than 5000 trips per day. Thus, the proposed system can feasibly provide a quick response service