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Aspirin plus clopidogrel in acute minor ischaemic stroke or transient ischaemic attack is superior to aspirin alone for stroke risk reduction: CHANCE trial
Commentary on: Wang Y, Wang Y, Zhao X, et al.. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11–19. Context Combination therapy with aspirin added to clopidogrel has had a disappointing record in the prevention of recurrent stroke. The management of atherothrombosis with clopidogrel in high-risk patients (MATCH)1 and the secondary prevention of small subcortical strokes (SPS3)2 randomised controlled trials (RCTs) showed that combination therapy was not more effective than clopidogrel or aspirin alone, but was associated with two to three times the risk of major or ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Gorelick, P. B., Farooq, M. U. Tags: Smoking and tobacco, Clinical trials (epidemiology), Genetics, Stroke, Hypertension, Diabetes, Health education, Smoking Therapeutics Source Type: research

Effects of Antiplatelet Agents on Functional Outcome and Cognitive Status in Patients with Acute Ischemic Stroke
Conclusion The use of antiplatelet agents in acute ischemic stroke may have a favorable effect on functional outcome and cognitive status in patients at 3 months poststroke.
Source: International Journal of Gerontology - November 17, 2014 Category: Geriatrics Source Type: research

Secondary prevention of stroke in elderly people in Poland-Results of PolSenior study.
CONCLUSIONS: Secondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly. PMID: 24821632 [PubMed - in process]
Source: Neurologia i Neurochirurgia Polska - March 1, 2014 Category: Neurology Authors: Labuz-Roszak B, Skrzypek M, Pierzchała K, Machowska-Majchrzak A, Mossakowska M, Chudek J, Mańka-Gaca I, Bartman W, Więcek A Tags: Neurol Neurochir Pol Source Type: research

Secondary prevention of stroke in elderly people in Poland--results of PolSenior study.
CONCLUSIONS: Secondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly. PMID: 24821632 [PubMed - indexed for MEDLINE]
Source: Neurologia i Neurochirurgia Polska - August 24, 2014 Category: Neurology Authors: Labuz-Roszak B, Skrzypek M, Pierzchała K, Machowska-Majchrzak A, Mossakowska M, Chudek J, Mańka-Gaca I, Bartman W, Więcek A Tags: Neurol Neurochir Pol Source Type: research

Lack of association between proton pump inhibitors and adverse events in patients taking clopidogrel and aspirin
Commentary on Douglas IJ, Evans SJ, Hingorani AD, et al.. Clopidogrel and interaction with proton pump inhibitors: comparison between cohort and within person study designs. BMJ 2012;345:e4388 Context Clopidogrel inhibits the P2Y12 platelet receptor and is used in patients with acute coronary syndromes or ischaemic stroke to prevent recurrent vascular events. Proton pump inhibitors (PPIs), however, have been shown to reduce the pharmacodynamic effect of clopidogrel upon platelet inhibition, and have been linked in retrospective studies to a higher rate of ischaemic outcomes in patients taking clopidogrel. Methods A total o...
Source: Evidence-Based Medicine - May 15, 2013 Category: Internal Medicine Authors: Waksman, R., Gaglia, M. A. Tags: Smoking and tobacco, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Health education, Smoking Aetiology Source Type: research

Safety of OnabotulinumtoxinA Treatment With Concomitant Antithrombotic Therapy in Patients With Post-stroke Spasticity: A Pooled Analysis of Randomized, Double-Blind Studies (S56.008)
Conclusions:There is no apparent increased risk of bleeding complications in patients on antithrombotics following IM onabotA treatment; nonetheless, careful observation of the injection site and patient education of the potential for bleeding complications remain warranted.Study Supported by: Allergan plc, Dublin, IrelandDisclosure: Dr. Dimitrova has received personal compensation for activities with Allergan as an employee. Dr. Dimitrova holds stock and/or stock options in Allergan. Dr. James has received personal compensation for activities with Allergan and Chase Pharmaceuticals as an employee. Dr. Liu has received per...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Dimitrova, R., James, L., Liu, C., Orejudos, A., Yushmanova, I., Brin, M. Tags: Movement Disorders: Huntington ' s Disease and Drug-Induced Dyskinesias Source Type: research

FDA Approves Expanded Peripheral Artery Disease (PAD) Indication for XARELTO ® (rivaroxaban) Plus Aspirin to Include Patients After Lower-Extremity Revascularization (LER) Due to Symptomatic PAD
RARITAN, N.J., August 24, 2021 – The Janssen Pharmaceutical Companies of Johnson & Johnson today announced that the U.S. Food and Drug Administration (FDA) has approved an expanded peripheral artery disease (PAD) indication for the XARELTO® (rivaroxaban) vascular dose (2.5 mg twice daily plus aspirin 100 mg once daily) to include patients following recent lower-extremity revascularization (LER) due to symptomatic PAD. The approval is based on data from the Phase 3 VOYAGER PAD study. With this approval, XARELTO® is the first and only therapy indicated to help reduce the risks of major cardiovascular (CV) events in p...
Source: Johnson and Johnson - August 24, 2021 Category: Pharmaceuticals Tags: Innovation Source Type: news

Acute ischemic cerebrovascular events on antiplatelet therapy: What is the optimal prevention strategy?
Abstract Even though patients who develop ischemic stroke despite taking antiplatelet drugs represent a considerable proportion of stroke hospital admissions, there is a paucity of data from investigational studies regarding the most suitable therapeutic intervention. There have been no clinical trials to test whether increasing the dose or switching antiplatelet agents reduces the risk for subsequent events. Certain issues have to be considered in patients managed for a first or recurrent stroke while receiving antiplatelet agents. Therapeutic failure may be due to either poor adherence to treatment, associated c...
Source: Current Pharmaceutical Design - December 26, 2012 Category: Drugs & Pharmacology Authors: Milionis H, Michel P Tags: Curr Pharm Des Source Type: research

Prevalence and predictors of inappropriate apixaban dosing in patients with non-valvular atrial fibrillation at a large tertiary academic medical institution
ConclusionIn patients with NVAF receiving apixaban for stroke prevention in this real-world analysis,>  80% were prescribed an appropriate dosage of apixaban. Proactive procedures, such as integrating an electronic dosing algorithm, educating healthcare providers, and involving clinical pharmacists in medication review, may help ensure the use of appropriate apixaban dosages.
Source: Drugs and Therapy Perspectives - December 4, 2019 Category: Drugs & Pharmacology Source Type: research

Novel Oral Anticoagulants
Abstract: Warfarin has a proven record as an oral anticoagulant; almost every study, however, has found that it is not prescribed for 40–60% of patients who are eligible and should receive it, and of those who do receive it, serum warfarin levels only achieved a time in therapeutic range (TTR) equal to INR 2–3 about 55–60% of the time (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This means that only about 1 in 4 patients are adequately anticoagulated with warfarin, and thus there is a large unmet need for achieving better anticoagulation in these patients. Although...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

Who might benefit from early aspirin after coronary artery surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether early administration of aspirin might optimize vein graft patency. More than 250 papers were found using the reported search, of which 4 new papers in addition to the previous 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Early postoperative aspirin administered within 6 h following coronary artery bypass grafting (CABG) has been show...
Source: Interactive CardioVascular and Thoracic Surgery - August 14, 2014 Category: Cardiovascular & Thoracic Surgery Authors: Gukop, P., Gutman, N., Bilkhu, R., Karapanagiotidis, G. T. Tags: Cardiac - physiology, Education, Congestive Heart Failure, Molecular biology Adult Cardiac Source Type: research

Pharmacogenomics of antiplatelet drugs.
Authors: Sabatine MS, Mega JL Abstract Clopidogrel, a platelet P2Y12 inhibitor, is one of the most widely prescribed drugs in cardiovascular medicine because it reduces ischemic and thrombotic complications. It is a prodrug requiring biotransformation into the active metabolite by the hepatic cytochrome 450 system, especially the CYP2C19 enzyme. Candidate gene studies and genome-wide association studies have identified loss-of-function CYP2C19 variants to be associated with a diminished pharmacologic response. Specifically, compared with noncarriers, carriers of at least one copy of a loss-of-function CYP2C19 allel...
Source: Hematology ASH Education Program - February 20, 2015 Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research