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Comment Learning from TARDIS: time for more focused trials in stroke prevention
Antithrombotic therapy immediately following stroke is important to minimise the risk of recurrence, but the optimum choice and number of drugs to use are unclear, and efficacy in preventing thrombosis needs to be weighed against bleeding risk. In The Lancet, the TARDIS investigators report findings from a randomised trial1 that tested intensive antiplatelet therapy with three agents (aspirin, clopidogrel, and dipyridamole) against therapy based on current UK guidelines2 (either clopidogrel, or aspirin plus dipyridamole) for 30 days in patients with transient ischaemic attack (TIA) or ischaemic stroke.
Source: LANCET - December 20, 2017 Category: General Medicine Authors: Pierre Amarenco Tags: Comment Source Type: research

Articles Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial
Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice.
Source: LANCET - December 20, 2017 Category: General Medicine Authors: Philip M Bath, Lisa J Woodhouse, Jason P Appleton, Maia Beridze, Hanne Christensen, Robert A Dineen, Lelia Duley, Timothy J England, Katie Flaherty, Diane Havard, Stan Heptinstall, Marilyn James, Kailash Krishnan, Hugh S Markus, Alan A Montgomery, Stuart Tags: Articles Source Type: research

Comment Secondary prevention shifts into second gear
Aspirin has been a mainstay in the secondary prevention of cardiovascular events since the 1990s.1 In the mid-1990s, the antiplatelet clopidogrel was tested against aspirin in patients with atherosclerotic vascular disease and was found to reduce vascular death, ischaemic stroke, and myocardial infarction by 8 ·7%.2 The combination of clopidogrel and aspirin for secondary prevention to reduce cardiovascular events was tested in patients with symptomatic atherothrombosis; however, no benefit was observed.
Source: LANCET - November 10, 2017 Category: General Medicine Authors: E Magnus Ohman Tags: Comment Source Type: research

Comment Preventing major gastrointestinal bleeding in elderly patients
Antiplatelet therapy is the most frequently recommended treatment to prevent recurrent ischaemic events in patients who have had an ischaemic stroke, an acute coronary syndrome, or symptomatic peripheral arterial disease. The most frequently used drugs are aspirin or clopidogrel. Most guidelines recommend lifelong intake of antiplatelet therapy. However, randomised trials that have investigated the benefit of antiplatelet therapy had an observation period of between 2 years and 4 years.1 Therefore, we lack data on the long-term benefit and risk of antiplatelet therapy across long time periods, particularly in elderly patients.
Source: LANCET - June 13, 2017 Category: General Medicine Authors: Hans-Christoph Diener Tags: Comment Source Type: research

Clinical Picture Ischaemic scalp ulceration and hair loss
A 46-year-old woman presented to our outpatient clinic in June, 2013, with frequent collapse, ischaemic scalp ulcerations, and hair loss (). She had undergone carotid endarterectomy in 2005, after a small right hemispheric stroke, and had no other medical history apart from hypercholesterolaemia. She had no previous dermatological or scalp problems. She took clopidogrel 75 mg, aspirin 80 mg, and simvastatin 40 mg daily.
Source: LANCET - October 11, 2014 Category: Journals (General) Authors: Çağdaş Ünlü, Jean-Paul P M de Vries Tags: Clinical Picture Source Type: research