By Richard C Becker, Frederick A Spencer
Stroke is the commonest reason behind grownup mortality within the usa. Antithrombotic brokers shape the mainstay of stroke prevention. Aspirin produces a modest aid within the hazard of moment stroke and brief ischemic assault (TIA, mini-stroke) and is broadly advised for preliminary remedy. The thienopyridines (Ticlid) and clopodogrel (Plavix) are choices for secondary prevention in sufferers who don't reply to or can't take aspirin. they're not more powerful than aspirin and feature been linked to thrombotic thrombocytopenic purpura. the combo of aspirin and extended-release dipyridamole (Aggrenox) has numerous mechanisms of motion and an additive influence on lowering stroke threat in comparison with both agent by myself. A 2-fold raise in hazard aid and favorable safeguard profile recommend that the combo can function first-line prophylaxis opposed to a moment stroke. This quantity, as a part of the Oxford American Pocket Note sequence, presents the clinician wtih updated details at the instructions, and healing recommendations in recurrent stroke/TIA prevention. invaluable positive aspects comprise remedy algorithms, illustrations, drugs tables, charts and figures to allow either the professional and the first supplier to make sure the simplest thoughts to their sufferers in an effort to hinder the reocurrence of stroke/TIA.
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Extra info for Antithrombotic Therapy in Prevention of Ischemic Stroke
Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 2006;367(9523):1665–73. 45. , et al; PRoFESS Study Group. Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 2008 Sep 18;359(12):1238–51. 46. , et al; Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study group. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, 44 ANTITHROMBOTIC THERAPY active and placebo-controlled study.
A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of aschaemic events (CAPRIE). Lancet 1996;348(9038):1329-39. With permission from Elsevier. There were no major differences in safety between treatment groups; however, a greater proportion of patients receiving aspirin had the study drug permanently discontinued because of gastrointestinal hemorrhage, indigestion, nausea, or vomiting. 2 × 109/L) (similar to aspirin treatment). In the CAPRIE study,33 all-cause mortality, vascular death, MI, stroke, and rehospitalization rates were determined for 1,480 patients who had previously undergone bypass grafting.
For the TIA Working Group. Transient ischemic attack—proposal for a new defi nition. N Engl J Med 2002;347:1713–6. 3. Mackman N. Triggers, targets and treatments for thrombosis. Nature 2008;451(7181):914–8. 4. Burke AP, Farb A, Malcolm GT, et al. Coronary risk factors and plaque morphology in men with coronary artery disease who died suddenly. N Engl J Med 1997;336:1276–82. 5. McEver RP. Adhesive interactions of leukocytes, platelets, and the vessel wall during hemostasis and inflammation. Thromb Haemost 2001;86(3):746–56.
Antithrombotic Therapy in Prevention of Ischemic Stroke by Richard C Becker, Frederick A Spencer