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REVIEW
Tsung-Lin Lee, Yu-Ming Chang, Pi-Shan Sung
Antiplatelet therapy is the first-line management for noncardioembolic transient ischemic attack (TIA) and acute ischemic stroke (IS). Herein, we review the safety and efficacy of antiplatelet therapies in patients with IS and TIA, primarily focusing on the acute stage. We discuss current antiplatelet monotherapy and the factors influencing efficacy and continuation rate according to clinical trial data. Aspirin remains the most commonly used first-line antiplatelet agent for preventing noncardioembolic stroke recurrence, and clopidogrel, cilostazol, and ticagrelor are feasible alternatives...
September 30, 2023: Acta Neurologica Taiwanica
#22
JOURNAL ARTICLE
Mingxia Li, Qianru Yang, Jiankuan Shi, Xiaolong Zhang, Hong Lin, Fangfang Ge
BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel was recommended as the secondary prevention of minor ischemic stroke or transient ischaemic attack (TIA). However, genetic polymorphisms of CYP2C19 had been identified as the major cause of poor responsiveness to clopidogrel. Ticagrelor, unlike clopidogrel, did not depend on metabolic activation, but it remained unclear whether ticagrelor was superior to clopidogrel in ischemic stroke. We performed a network meta-analysis to compare the efficacy and safety of ticagrelor, clopidogrel, and aspirin in the minor ischemic stroke and TIA populations...
August 14, 2023: BMC Neurology
#23
JOURNAL ARTICLE
Lisa J Woodhouse, Jason P Appleton, Hanne Christensen, Rob A Dineen, Timothy J England, Marilyn James, Kailash Krishnan, Alan A Montgomery, Anna Ranta, Thompson G Robinson, Nikola Sprigg, Philip M Bath
Intensive antiplatelet therapy did not reduce recurrent stroke/transient ischaemic attack (TIA) events as compared with guideline treatment in the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial, but did increase the frequency and severity of bleeding. In this pre-specified analysis, we investigated predictors of bleeding and the association of bleeding with outcome. TARDIS was an international prospective randomised open-label blinded-endpoint trial in participants with ischaemic stroke or TIA within 48 h of onset...
July 20, 2023: Scientific Reports
#24
RANDOMIZED CONTROLLED TRIAL
Jia Zhang, Anxin Wang, Xue Tian, Xia Meng, Xuewei Xie, Jing Jing, Jinxi Lin, Yilong Wang, Zixiao Li, Liping Liu, Hao Li, Yong Jiang, Xingquan Zhao, Yongjun Wang
BACKGROUND: Body mass index (BMI) may affect the response to platelet P2Y12 receptor inhibitors. We aimed to explore whether BMI influenced the efficacy and safety of ticagrelor and clopidogrel for secondary prevention of minor ischemic stroke or transient ischemic attack (TIA) among patients enrolled in the CHANCE-2 (Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial. METHODS: In a multicentre, randomized, double-blind, placebo-controlled trial, conducted in China, we randomized patients with minor stroke or TIA who carried the CYP2C19 loss-of-function allele to receive either ticagrelor-acetylsalicylic acid (ASA) or clopidogrel-ASA...
July 10, 2023: Canadian Medical Association Journal: CMAJ
#25
JOURNAL ARTICLE
A A Kulesh, S N Yanishevskiy, D A Demin, L I Syromyatnikova, O I Vinogradov
High and very high risk atherothrombotic ischemic stroke (ATIS) includes patients with severe extracranial atherosclerosis, any intracranial atherosclerosis, and aortic arch atheromatosis. The article discusses the most effective approaches to medical short- and long-term secondary prevention of ATIS, major vascular events and death, based on the results of modern research and current clinical guidelines. Clinical studies of recent years have proven the possibility of individualization and intensification of secondary prevention of ATIS...
2023: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
#26
RANDOMIZED CONTROLLED TRIAL
Xuewei Xie, S Claiborne Johnston, Anxin Wang, Qin Xu, Philip M Bath, Yuesong Pan, Hao Li, Jinxi Lin, Yilong Wang, Xingquan Zhao, Zixiao Li, Yong Jiang, Liping Liu, Anding Xu, Jing Jing, Xia Meng, Yongjun Wang
IMPORTANCE: The Clopidogrel With Aspirin in High-Risk Patients With Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial showed that ticagrelor-aspirin combination therapy reduced the risk of stroke compared with a clopidogrel-aspirin combination among carriers of CYP2C19 loss-of-function (LOF) alleles after a transient ischemic attack (TIA) or minor ischemic stroke. However, the association between the degree of CYP2C19 LOF and ideal treatment allocation remains unknown. OBJECTIVE: To investigate whether the efficacy and safety of ticagrelor-aspirin vs clopidogrel-aspirin are consistent with the expected degree of CYP2C19 LOF after TIA or minor stroke...
June 1, 2023: JAMA Network Open
#27
JOURNAL ARTICLE
Hongyu Zhou, Yuesong Pan, Weiqi Chen, Yue Suo, Hongyi Yan, Xia Meng, Xingquan Zhao, Liping Liu, Hao Li, Yongjun Wang
INTRODUCTION: To investigate the impact of smoking on dual antiplatelet therapy in patients with minor stroke or transient ischemic attack (TIA) under different glycated albumin (GA) levels. METHODS: We analyzed data from the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial. A subgroup of 3044 patients with baseline GA levels was included and categorized by smoking status and GA levels. The primary efficacy outcome was a new stroke within 90 days...
June 1, 2023: Cerebrovascular Diseases
#28
Mohammad Ala' Alajjuri, Omar Ala' Alajjuri, Firas Raouf Alani
Lambl's excrescence (LE), a rare thin linear fibrous thread of collagen and elastic fibrous tissue originating at closure margins of heart valve leaflets is considered a rare cause of thromboembolism, causing ischemic stroke, transient ischemic attack (TIA), acute coronary syndrome, or peripheral thromboembolism. The gold standard for diagnosing LE is transesophageal echocardiography (TEE). Due to the rarity of the disease and lack of significant research, no guidelines exist about the management of LE. Twenty-two papers about LE were reviewed, focusing on the management aspect aiming to assist in guideline publication...
2023: Clinical Medicine Insights. Case Reports
#29
JOURNAL ARTICLE
Victor L Serebruany, Jean-Francois Tanguay, Milana L Gurvich, Thomas A Marciniak, Dan Atar
BACKGROUND: The incidence of stroke/TIA during annual dual antiplatelet therapy (ADAPT) for acute coronary syndrome (ACS) remains high. Some evidence suggests that shorter than ADAPT may diminish such risk, still providing adequate vascular protection. However, the precise timing of strokes/TIA occurrences during ADAPT is unclear but may be important for determining optimal preventive treatment duration. STUDY QUESTION: The precise timing of secondary cerebrovascular events over ADAPT...
March 29, 2023: American Journal of Therapeutics
#30
JOURNAL ARTICLE
Mengqi Han, Weijie Jia, Yifan Wu, Jie Kuang, Jianglong Tu, Shujuan Yin, Jibiao Chen, Xiaolin Zhang, Jingyi Li, Yongsen Chen, Bin Wu, Yingping Yi
AIM The aim of this study was to determine whether the testing strategy for clopidogrel and/or aspirin resistance using CYP2C19 genotyping or urinary 11-dhTxB2 testing has an impact on clinical outcomes. METHODS A multicentre, randomized, controlled trial was conducted at 14 centres in China from 2019 to 2021. For the intervention group, a specific antiplatelet strategy was assigned based on the CYP2C19 genotype and 11-dhTxB2, a urinary metabolite of aspirin, and the control group received non-guided (i.e., standard of care) treatment...
May 9, 2023: British Journal of Clinical Pharmacology
#31
Xibo Ma, Danfeng Li, Shihua Liu, Yan Chen, Ping Zhong
INTRODUCTION: Currently, it is still controversial to treat stroke with ticagrelor alone. The purpose of our study was to systematically review and analyze the efficacy and safety of ticagrelor on cerebrovascular outcomes in patients with vascular risk factors. METHODS: The PubMed, Cochrane Library, and Embase databases were systematically searched using the keywords stroke, ticagrelor, clopidogrel, and aspirin to identify randomized controlled trials (RCTs). Primary outcomes included reported stroke, ischemic stroke, and complex events; the secondary outcome was hemorrhagic stroke...
2023: European Neurology
#32
REVIEW
Kunal Bhatia, Lindsey M Ladd, Kelsey H Carr, Mario Di Napoli, Jeffrey L Saver, Louise D McCullough, Maryam Hosseini Farahabadi, Diana L Alsbrook, Archana Hinduja, Jorge G Ortiz Garcia, Sara Y Sabbagh, Alibay Jafarli, Afshin A Divani
PURPOSE OF REVIEW: Stroke is a leading cause of death and disability worldwide. The annual incidence of new or recurrent stroke is approximately 795,000 cases per year in the United States, of which 87% are ischemic in nature. In addition to the management of modifiable high-risk factors to reduce the risk of recurrent stroke, antithrombotic agents (antiplatelets and anticoagulants) play an important role in secondary stroke prevention. This review will discuss the published literature on the use of antiplatelets and anticoagulants in secondary prevention of acute ischemic stroke and transient ischemic attack (TIA), including their pharmacology, efficacy, and adverse effects...
May 2023: Current Neurology and Neuroscience Reports
#33
JOURNAL ARTICLE
Adam Edward Lang, Adam de Havenon, Brian Mac Grory, Nils Henninger, Liqi Shu, Karen L Furie, J Donald Easton, Anthony Kim, S Claiborne Johnston, Shadi Yaghi
BACKGROUND: The aim of this study was to determine the effect of smoking status on subsequent stroke risk in patients with minor ischemic stroke or TIA and to determine whether smoking modifies the effect of clopidogrel-based DAPT on subsequent stroke risk. METHODS: This was a post-hoc analysis of the Platelet Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, which had a 90-day follow-up period. We used multivariable Cox regression and subgroup interaction analysis to determine the effect of smoking on the risk of subsequent ischemic stroke and major hemorrhage, respectively...
March 2023: European Stroke Journal
#34
JOURNAL ARTICLE
Eleonora De Matteis, Federico De Santis, Raffaele Ornello, Bruno Censori, Valentina Puglisi, Luisa Vinciguerra, Alessia Giossi, Pietro Di Viesti, Vincenzo Inchingolo, Giovanni Matteo Fratta, Marina Diomedi, Maria Rosaria Bagnato, Silvia Cenciarelli, Chiara Bedetti, Chiara Padiglioni, Tiziana Tassinari, Valentina Saia, Alessandro Russo, Marco Petruzzellis, Domenico Maria Mezzapesa, Martina Caccamo, Giuseppe Rinaldi, Alessandra Bavaro, Maurizio Paciaroni, Maria Giulia Mosconi, Matteo Foschi, Pietro Querzani, Francesco Muscia, Serena Gallo Cassarino, Paolo Candelaresi, Antonio De Mase, Maria Guarino, Letizia Maria Cupini, Enzo Sanzaro, Andrea Zini, Salvatore La Spada, Carmela Palmieri, Federica Nicoletta Sepe, Simone Beretta, Cristina Paci, Emanuele Alessandro Caggia, Maria Vittoria De Angelis, Laura Bonanni, Gino Volpi, Rossana Tassi, Francesca Pistoia, Umberto Scoditti, Agnese Tonon, Giovanna Viticchi, Giampietro Ruzza, Patrizia Nencini, Anna Cavallini, Danilo Toni, Stefano Ricci, Simona Sacco
BACKGROUND: Randomized controlled trials (RCTs) proved that short-term (21-90 days) dual antiplatelet therapy (DAPT) reduces the risk of early ischemic recurrences after a noncardioembolic minor stroke or high-risk transient ischemic attack (TIA) without substantially increasing the hemorrhagic risk. We aimed at understanding whether and how real-world use of DAPT differs from RCTs. METHODS: READAPT (Real-Life Study on Short-Term Dual Antiplatelet Treatment in Patients With Ischemic Stroke or TIA) is a prospective cohort study including >18-year-old patients treated with DAPT after a noncardioembolic minor ischemic stroke or high-risk TIA from 51 Italian centers...
May 2023: Stroke; a Journal of Cerebral Circulation
#35
JOURNAL ARTICLE
Lotte van den Heuvel, Henricus J Vermeer, Henk Kerkhoff, Bob Roozenbeek, Elles Zock
INTRODUCTION: The CYP2C19 enzyme converts clopidogrel into an active metabolite. Carriers of CYP2C19 loss-of-function (LOF) variants with a history of ischemic stroke or transient ischemic attack (TIA) using clopidogrel may have a higher risk of recurrent stroke. To study the implications of genetic CYP2C19 heterogeneity in treatment of cerebral ischemia, knowledge about the prevalence of CYP2C19 LOF variants within the population is important. We investigated the frequency of CYP2C19 LOF variants in patients with non-cardioembolic ischemic stroke or TIA in the Dutch population...
March 22, 2023: Cerebrovascular Diseases
#36
JOURNAL ARTICLE
Hai-Xia Song, Bin Zhang, Shan Liu, Zhi-Chao Shi, Zi-Yun Wang, Hai-Li Lu, Jie Yao, Juan Chen
BACKGROUND: As one of the most common causes of stroke, symptomatic intracranial artery stenosis (sICAS) is a great threat to public health, and its financial burden is substantial, with annual direct high medical costs particularly in China. Currently, the long-term use of conventional dual antiplatelet therapy (DAPT) as the primary modality of treatment for sICAS decreases the risk of stroke recurrence but increases the risk of bleeding. We aimed to evaluate the efficacy and safety of low dose aspirin plus clopidogrel for the treatment of sICAS in the elderly population...
2023: Frontiers in Neurology
#37
JOURNAL ARTICLE
Ellen O'Brien, Dejan Milentijevic, Rajarshi Roychowdhury, Smita Mitra, Cindy Y Chen
OBJECTIVE: Patients who have an ischemic stroke (IS) or transient ischemic attack (TIA) are at risk of having a secondary stroke. Single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) may be recommended for secondary stroke prevention (SSP), depending on severity and etiology. This study evaluated outpatient antiplatelet treatment patterns for SSP and outcomes after first hospitalization for IS/TIA among adults without atrial fibrillation in the United States. MATERIALS AND METHODS: This retrospective observational study utilized data from an adjudicated administrative health claims database...
February 2023: Heliyon
#38
RANDOMIZED CONTROLLED TRIAL
Ying Gao, Yuesong Pan, Shangrong Han, Weiqi Chen, Jing Jing, Chunjuan Wang, Yingying Yang, Tingting Wang, Xia Meng, Xingquan Zhao, Liping Liu, Hao Li, S Claiborne Johnston, Pierre Amarenco, Philip M Bath, Yongjun Wang, Yilong Wang
BACKGROUND: It remains unclear if intensive antiplatelet and statin treatments begun within 24-72 hours of cerebral ischaemic events from intracranial or extracranial atherosclerosis is effective or safe. METHODS: The Intensive Statin and Antiplatelet Therapy for High-risk Intracranial or Extracranial Atherosclerosis (INSPIRES) trial is a randomised, double-blind, placebo-controlled, multicentre and 2×2 factorial trial. 6100 individuals between the ages of 35 and 80 who have experienced a mild ischaemic stroke or high-risk transient ischaemic attack (TIA) within the previous 72 hours that is attributed to ≥50% atherosclerotic stenosis of a major intracranial or extracranial artery or multiple infarctions of atherosclerotic origin will be enrolled in the trial...
June 2023: Stroke and Vascular Neurology
#39
JOURNAL ARTICLE
Huihui Liu, Jing Jing, Anxin Wang, Qin Xu, Xia Meng, Hao Li, Zixiao Li, Yongjun Wang
BACKGROUND AND OBJECTIVES: Single small subcortical infarction (SSSI) is an important stroke subtype. The optimal antiplatelet medication for ischemic stroke patients with an SSSI is still unclear. We aimed to test the efficacy and safety of ticagrelor-aspirin in preventing stroke recurrence among SSSI patients in the Ticagrelor or Clopidogrel with Aspirin in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial. METHODS: In the CHANCE-2 trial, patients with a minor stroke or transient ischemic attack (TIA) who carried CYP2C19 loss-of-function (LOF) alleles were randomly assigned within 24 hours after symptom onset, to either ticagrelor-aspirin (placebo clopidogrel plus a 180 mg loading dose of ticagrelor on Day 1, followed by 90 mg twice daily on Days 2-90) or clopidogrel-aspirin (placebo ticagrelor plus a 300 mg loading dose of clopidogrel on Day 1, followed by 75 mg daily on Days 2-90)...
January 25, 2023: Neurology
#40
JOURNAL ARTICLE
Jing Jing, Xuewei Xie, S Claiborne Johnston, Philip M Bath, Zixiao Li, Xingquan Zhao, Liping Liu, Yilong Wang, Qin Xu, Anxin Wang, Yong Jiang, Hao Li, Xia Meng, Yongjun Wang
OBJECTIVE: This study was performed to investigate whether ticagrelor/aspirin versus clopidogrel/aspirin can further reduce the residual risk of stroke recurrence in patients with positive diffusion-weighted imaging (DWI) in the High-Risk Patients with Acute Nondisabling Cerebrovascular Events II (CHANCE-2) trial. METHODS: Patients with DWI data in the CHANCE-2 trial were included and divided into those with and without acute infarction according to their DWI findings...
April 2023: Annals of Neurology
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