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https://www.readbyqxmd.com/read/27816341/stroke-prevention
#1
Clothilde Isabel, David Calvet, Jean-Louis Mas
Patients who have had a stroke are at high risk for recurrent stroke, myocardial infarction, and vascular death. Prevention of these events should be initiated promptly after stroke, because many recurrent events occur early, and should be tailored to the precise cause of stroke, which may require specific treatment. Lifestyle advice including abstinence from smoking, regular exercise, Mediterranean-style diet, and reduction of salt intake and alcohol consumption are recommended for all patients with stroke...
November 3, 2016: La Presse Médicale
https://www.readbyqxmd.com/read/27806998/genetic-polymorphisms-and-clopidogrel-efficacy-for-acute-ischemic-stroke-or-transient-ischemic-attack-a-systematic-review-and-meta-analysis
#2
Yuesong Pan, Weiqi Chen, Yun Xu, Xingyang Yi, Yan Han, Qing-Wu Yang, Xin Li, Li'an Huang, S Claiborne Johnston, Xingquan Zhao, Liping Liu, Qi Zhang, Guangyao Wang, Yongjun Wang, Yilong Wang
BACKGROUND: -The association of genetic polymorphisms and clopidogrel efficacy in patients with ischemic stroke or transient ischemic attack (TIA) remains controversial. We performed a systematic review and meta-analysis to assess the association between genetic polymorphisms, especially CYP2C19 genotype, and clopidogrel efficacy for ischemic stroke or TIA. METHODS: -We conducted a comprehensive search of the PubMed and EMBASE from their inceptions to June 24, 2016...
November 2, 2016: Circulation
https://www.readbyqxmd.com/read/27613582/abnormal-glucose-regulation-increases-stroke-risk-in-minor-ischemic-stroke-or-tia
#3
Yuesong Pan, Jing Jing, Hao Li, Yongjun Wang, Yilong Wang, Yan He
OBJECTIVE: To investigate whether abnormal glucose regulation contributes to a new stroke in patients with a minor ischemic stroke or TIA. METHODS: We derived data from the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events trial. Patients with a minor stroke or TIA were categorized into 3 groups: patients with diabetes mellitus (DM), impaired fasting glucose (IFG), and normal fasting plasma glucose. The primary outcome was a new stroke (ischemic or hemorrhagic) at 90 days...
October 11, 2016: Neurology
https://www.readbyqxmd.com/read/27461564/antiplatelet-and-anticoagulant-therapies-for-prevention-of-ischemic-stroke
#4
Nikhil Kapil, Yvonne H Datta, Naila Alakbarova, Eric Bershad, Magdy Selim, David S Liebeskind, Ornina Bachour, Gundu H R Rao, Afshin A Divani
Ischemic stroke represents one of the leading causes of death and disability in both the United States and abroad, particularly for patients with prior ischemic stroke or transient ischemic attack (TIA). A quintessential aspect of secondary stroke prevention is the use of different pharmacological agents, mainly antiplatelets and anticoagulants. Antiplatelets and anticoagulants exhibit their effect by blocking the activation pathways of platelets and the coagulation cascade, respectively. Clinical trials have demonstrated the safety and efficacy of antiplatelets for noncardioembolic stroke prevention, while anticoagulants are more often used for cardioembolic stroke prevention...
July 26, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27423556/the-curative-effect-comparison-of-two-kinds-of-therapeutic-regimens-on-decreasing-the-relative-intensity-of-microembolic-signal-in-clair-trial
#5
Q Q Deng, J Tang, C Chen, H Markus, Y N Huang, H Zhao, D Ratanakorn, K S L Wong, J H Fu
BACKGROUND: Microembolic signals (MESs) are direct markers of unstable large artery atherosclerotic plaques. In a previous study, we found that the number of MESs is associated with stroke recurrence and that clopidogrel plus aspirin more effectively reduce the number of MESs than does aspirin alone. Stroke recurrence is associated with not only the number of MESs but also the size of the MES, which can theoretically be estimated by monitoring the MES intensity via transcranial doppler (TCD)...
August 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27333757/-cerebral-infarction-and-transient-ischemic-attack
#6
REVIEW
Noriyuki Sahara, Takahiro Kuwashiro, Yasushi Okada
Japanese Guidelines for the Management of Stroke 2015 was published. Here, we describe several points revised from the 2009 edition about "Cerebral infarction and transient ischemic attack (TIA)". The revision points are as follows; 1. Extension of possible time window of intravenous recombinant tissue-plasminogen activator treatment (from within 3 hours to within 4.5 hours); 2. Antiplatelet therapy in acute stage (dual antiplatelet therapy (DAPT) for non-cardioembolic ischemic stroke or TIA); 3. Endovascular recanalization therapy in acute stage; 4...
April 2016: Nihon Rinsho. Japanese Journal of Clinical Medicine
https://www.readbyqxmd.com/read/27021849/dual-antiplatelet-therapy-after-stroke-or-transient-ischaemic-attack-how-long-to-treat-the-duration-of-aspirin-plus-clopidogrel-in-stroke-or-transient-ischaemic-attack-a-systematic-review-and-meta-analysis
#7
F Ge, H Lin, Y Liu, M Li, R Guo, Z Ruan, T Chang
BACKGROUND AND PURPOSE: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 90 days was recommended as the secondary prevention of minor ischaemic strokes or transient ischaemic attacks (TIAs) in 2014. However, whether the duration of 90 days is optimal for each patient remains unclear. Therefore, the efficacy and safety of short-term (≤3 months) and prolonged (≥1 year) DAPT after stroke or TIA were assessed via a systematic review and meta-analysis. METHODS: The Cochrane Library, Clinical Trials...
June 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/26947237/dual-antiplatelet-therapy-reduces-stroke-but-increases-bleeding-at-the-time-of-carotid-endarterectomy
#8
Douglas W Jones, Philip P Goodney, Mark F Conrad, Brian W Nolan, Eva M Rzucidlo, Richard J Powell, Jack L Cronenwett, David H Stone
OBJECTIVE: Controversy persists regarding the perioperative management of clopidogrel among patients undergoing carotid endarterectomy (CEA). This study examined the effect of preoperative dual antiplatelet therapy (aspirin and clopidogrel) on in-hospital CEA outcomes. METHODS: Patients undergoing CEA in the Vascular Quality Initiative were analyzed (2003-2014). Patients on clopidogrel and aspirin (dual therapy) were compared with patients taking aspirin alone preoperatively...
May 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/26909820/when-a-single-antiplatelet-agent-for-stroke-prevention-is-not-enough-current-evidence-and-future-applications-of-dual-antiplatelet-therapy
#9
Kristy Yuan, Anthony S Kim
For secondary stroke prevention, long-term dual antiplatelet therapy is not recommended due to increased bleeding risks. There is no specific evidence for using dual antiplatelet therapy for cervical artery dissection or for adding a second antiplatelet agent after a stroke while taking aspirin monotherapy. For patients with atrial fibrillation and stroke/TIA unable to tolerate warfarin, aspirin monotherapy is reasonable. Dual antiplatelet therapy carries a similar risk of major bleeding as warfarin that offsets reductions in stroke risk...
April 2016: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/26850406/-meta-analysis-on-the-efficacy-and-adverse-events-of-aspirin-plus-clopidogrel-versus-aspirin-monotherapy-in-patients-with-ischemic-stroke-or-transient-ischemic-attack
#10
Cheng Yang, Jie Qian, Xun Tang, Pei Gao, Yonghua Hu
OBJECTIVE: To present the systematic assessment on the efficacy and bleeding adverse events of dual-antiplatelet therapy with aspirin and clopidogrel versus aspirin-mono-antiplatelet therapy in patients with ischemic stroke or transient ischemic attack. METHODS: Retrieve randomized controlled trials conformed to the inclusion and exclusion criteria in Cochrane Library, Medline, Embase, and Web of Science electronic database, between January 1, 1998 and April 1, 2015...
December 2015: Zhonghua Liu Xing Bing Xue za Zhi, Zhonghua Liuxingbingxue Zazhi
https://www.readbyqxmd.com/read/26846361/comparative-efficacy-and-safety-of-nine-anti-platelet-therapies-for-patients-with-ischemic-stroke-or-transient-ischemic-attack-a-mixed-treatment-comparisons
#11
Hua-Pin Huang, Wan-Hui Lin, Sheng-Gen Chen, Li-Zhen Chen, Min-Yi Chen, Chun-Hui Che
Anti-platelet treatments, an effective anti-thrombotic therapy, are widely used in non-cardioembolic ischemic stroke or transient ischemic attack (TIA), including aspirin, cilostazol, clopidogrel, and other mono or dual therapies, while the optimal choice remains uncertain. All the literatures of 38 eligible randomized control trials were searched in PubMed, Embase, and China National Knowledge Internet (CNKI) without language limitation. And, nine anti-platelet therapies were assessed, including aspirin, clopidogrel, cilostazol, ticlopidine, triflusal, terutroban, sarpogrelate, dipyridamole plus aspirin, and clopidogrel plus aspirin...
February 5, 2016: Molecular Neurobiology
https://www.readbyqxmd.com/read/26810509/continuation-and-adherence-rates-on-initially-prescribed-intensive-secondary-prevention-therapy-after-rapid-access-stroke-prevention-rasp-service-assessment
#12
Stephen J X Murphy, Catherine A Coughlan, Oliver Tobin, Justin Kinsella, Roisin Lonergan, Myles Gutkin, Dominick J H McCabe
INTRODUCTION: Consistent adherence to treatment is essential for effective secondary prevention following TIA/ischaemic stroke. Representative data on long-term treatment continuation and adherence rates are limited. METHODS: This single centre study recruited patients attending our Rapid Access Stroke Prevention clinic in Ireland from 07/09/2006 → 30/11/2009. Demographic and clinical data, and prescribed medication regimens at initial assessment were recorded...
February 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/26587656/cyp2c19-and-ces1-polymorphisms-and-efficacy-of-clopidogrel-and-aspirin-dual-antiplatelet-therapy-in-patients-with-symptomatic-intracranial-atherosclerotic-disease
#13
Brian L Hoh, Yan Gong, Caitrin W McDonough, Michael F Waters, Adrienne J Royster, Tiffany O Sheehan, Ben Burkley, Taimour Y Langaee, J Mocco, Scott L Zuckerman, Nishit Mummareddy, Marcus L Stephens, Christie Ingram, Christian M Shaffer, Joshua C Denny, Murray H Brilliant, Terrie E Kitchner, James G Linneman, Dan M Roden, Julie A Johnson
OBJECT Symptomatic intracranial atherosclerotic disease (ICAD) has a high risk of recurrent stroke. Genetic polymorphisms in CYP2C19 and CES1 are associated with adverse outcomes in cardiovascular patients, but have not been studied in ICAD. The authors studied CYP2C19 and CES1 single-nucleotide polymorphisms (SNPs) in symptomatic ICAD patients. METHODS Genotype testing for CYP2C19*2, (*)3, (*)8, (*)17 and CES1 G143E was performed on 188 adult symptomatic ICAD patients from 3 medical centers who were medically managed with clopidogrel and aspirin...
June 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/26391570/combined-clopidogrel-aspirin-treatment-for-high-risk-tia-or-minor-stroke-does-not-increase-cerebral-microbleeds
#14
RANDOMIZED CONTROLLED TRIAL
Zhiming Wang, Chenghua Xu, Peng Wang, Yilong Wang, Huaping Xin
OBJECTIVES: To study whether Clopidogrel-Aspirin combined treatment for high risk transient ischaemic attack (TIA) or minor stroke results in increased number of lesions associated with anti-thrombotic cerebral haemorrhage or cerebral micro-bleeds (CMB) than aspirin alone treatment. METHODS: The patients recruited in CHANCE test in our hospital participated in this study. We made a comparison between treatments Aspirin-Clopidogrel combined group and the Aspirin alone group in the numbers of CMB and subsequent cerebral haemorrhages...
November 2015: Neurological Research
https://www.readbyqxmd.com/read/26386103/dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-after-ischemic-stroke-a-review-of-the-evidence
#15
REVIEW
Kyle A Davis, Marta A Miyares, Eric Dietrich
PURPOSE: The safety and efficacy of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in the setting of secondary stroke prevention are reviewed. SUMMARY: Antiplatelet therapy has been shown to reduce the risk of numerous vascular events, especially in the setting of secondary prevention. DAPT with aspirin and another antiplatelet agent such as clopidogrel, prasugrel, or ticagrelor has become the main stay of acute coronary syndrome (ACS) management...
October 1, 2015: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/26330567/dual-antiplatelet-therapy-in-stroke-and-icas-subgroup-analysis-of-chance
#16
RANDOMIZED CONTROLLED TRIAL
Liping Liu, Ka Sing Lawrence Wong, Xinyi Leng, Yuehua Pu, Yilong Wang, Jing Jing, Xinying Zou, Yuesong Pan, Anxin Wang, Xia Meng, Chunxue Wang, Xingquan Zhao, Yannie Soo, S Claiborne Johnston, Yongjun Wang
UNLABELLED: AB OBJECTIVE: We aimed to investigate whether the efficacy and safety of clopidogrel plus aspirin vs aspirin alone were consistent between patients with and without intracranial arterial stenosis (ICAS), in the Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. METHODS: We assessed the interaction of the treatment effects of the 2 antiplatelet therapies among patients with and without ICAS, identified by magnetic resonance angiography (MRA) in CHANCE (ClinicalTrials...
September 29, 2015: Neurology
https://www.readbyqxmd.com/read/26311748/association-of-lp-pla2-a-and-early-recurrence-of-vascular-events-after-tia-and-minor-stroke
#17
Jinxi Lin, Hongwei Zheng, Brett L Cucchiara, Jiejie Li, Xingquan Zhao, Xianhong Liang, Chunxue Wang, Hao Li, Michael T Mullen, S Claiborne Johnston, Yilong Wang, Yongjun Wang
OBJECTIVE: To determine the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) measured in the acute period and the short-term risk of recurrent vascular events in patients with TIA or minor stroke. METHODS: We measured Lp-PLA2 activity (Lp-PLA2-A) in a subset of 3,201 participants enrolled in the CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) trial. Participants with TIA or minor stroke were enrolled within 24 hours of symptom onset and randomized to single or dual antiplatelet therapy...
November 3, 2015: Neurology
https://www.readbyqxmd.com/read/26303791/clopidogrel-resistance-after-minor-ischemic-stroke-or-transient-ischemic-attack-is-associated-with-radiological-cerebral-small-vessel-disease
#18
Annika Lundström, Håkan Wallén, Magnus von Arbin, Gun Jörneskog, Bruna Gigante, Karin Höeg Dembrower, Evaldas Laurencikas, Ann Charlotte Laska
BACKGROUND: The objective of this study was to compare nonresponders (NR) and responders (R) to clopidogrel with respect to presence of microvascular and macrovascular pathology in a cohort of patients with recent minor ischemic stroke (IS) or transient ischemic attack (TIA). METHODS: Seventy-two patients treated with clopidogrel after IS or TIA were evaluated 1 month after onset. Platelet aggregation was measured by multiple electrode aggregometry (Multiplate)...
October 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/26283758/effect-of-clopidogrel-with-aspirin-on-functional-outcome-in-tia-or-minor-stroke-chance-substudy
#19
RANDOMIZED CONTROLLED TRIAL
Xianwei Wang, Xingquan Zhao, S Claiborne Johnston, Ying Xian, Bo Hu, Chunxue Wang, David Wang, Liping Liu, Hao Li, Jiming Fang, Xia Meng, Anxin Wang, Yongjun Wang, Yilong Wang
OBJECTIVE: We compared the effect of clopidogrel plus aspirin vs aspirin alone on functional outcome and quality of life in the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial of aspirin-clopidogrel vs aspirin alone after acute minor stroke or TIA. METHODS: Participants were assessed at 90 days for functional outcome using the modified Rankin Scale (mRS) and quality of life using the EuroQol-5 Dimension (EQ-5D). Poor functional outcome was defined as mRS score of 2-6 at 90 days and poor quality of life as EQ-5D index score of 0...
August 18, 2015: Neurology
https://www.readbyqxmd.com/read/26283034/dual-antiplatelet-therapy-prior-to-expedited-carotid-surgery-reduces-recurrent-events-prior-to-surgery-without-significantly-increasing-peri-operative-bleeding-complications
#20
A Batchelder, J Hunter, V Cairns, R Sandford, A Munshi, A R Naylor
OBJECTIVE: A daily Rapid-Access TIA Clinic was introduced in 2008, where symptomatic patients were started on 75 mg aspirin + 40 mg simvastatin by the referring doctor, before attending the clinic. Following clinic assessment, patients with 50-99% stenoses were transferred to the vascular unit for carotid endarterectomy (CEA). In two audits (n = 212 patients), the median delay from transfer to the vascular unit to undergoing CEA was 3 days, during which time 28 patients (13%) suffered recurrent neurological events...
October 2015: European Journal of Vascular and Endovascular Surgery
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