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Cilostazol-based dual anti-platelet agents for Asian patients: An updated network meta-analysis
Antiplatelet therapy, including aspirin, has been used for the secondary prevention of non-cardioembolic ischemic stroke [1]. Because patients who have a higher risk of recurrent stroke need antiplatelet agents with higher efficacy than aspirin, dual antiplatelet therapy (DAPT) has been used in cases requiring higher efficacy, such as the acute stage of stroke or high-risk patients [2]. However, DAPT is notably associated with an increased risk of bleeding like a two-edged sword [3]. Aspirin plus clopidogrel is recommended for a few weeks after acute ischemic stroke, preventing bleeding risk from not exceeding the power of...
Source: Journal of the Neurological Sciences - October 8, 2022 Category: Neurology Authors: Seung Jin Jung, Sung Ryul Shim, Bum Joon Kim, Jin-Man Jung Source Type: research

Cilostazol improves endothelial function in patients with ischemic stroke: A randomized controlled single-center study with flow-mediated dilation technique
Recent CSPS.com study has shown the benefit of adding cilostazol on aspirin or clopidogrel for secondary stroke prevention [1]. Because a pleiotropic effect other than its anti-platelet effect such as vasodilatation and anti-atherosclerosis effect may underlie the effect [1], we examined the effects of adding cilostazol on clopidogrel on endothelial function in flow-mediated vasodilation (FMD) technique.
Source: Journal of the Neurological Sciences - June 8, 2022 Category: Neurology Authors: Yuka Shirai, Sono Toi, Utako Adachi, Yukiko Tsutsumi, Kazuo Kitagawa Source Type: research

Clopidogrel underactivity is a common in patients with acute symptomatic severe carotid stenosis
Clopidogrel is commonly used for secondary stroke prevention in patients with large vessel stenosis. Reduced Clopidogrel high on treatment platelet reactivity (CR) can lead to Clopidogrel underactivity (CU) causing acute thrombosis. However, the prevalence of CU among patients with acute symptomatic carotid disease remains unknown. Therefore, we aimed to find the prevalence and identify the predictors for CU among patients with acutely symptomatic carotid stenosis.
Source: Journal of the Neurological Sciences - April 14, 2021 Category: Neurology Authors: A. Honig, T. Sacagiu, A. Filioglo, N. Simaan, J. Kalish, J.M. Gomori, A. Horev, R.R. Leker, J.E. Cohen Tags: Clinical short communication Source Type: research

High on treatment platelet reactivity to aspirin and clopidogrel in ischemic stroke: A systematic review and meta-analysis
Emerging studies highlight high on-treatment of platelet reactivity (HTPR) as a major hindrance to the secondary prevention of cardiovascular ischemic events. The aim of this systematic review and meta-analysis is to assess the prevalence of HTPR in patients with ischemic stroke (IS) or transient ischemic attack (TIA) and reveal a possible relation with a higher risk of cerebrovascular event recurrence. Studies were selected if they reported absolute numbers or percentages of HTPR with ASA or clopidogrel in IS/TIA patients at any time point after the cerebrovascular event onset and assessed with any type of platelet function tests.
Source: Journal of the Neurological Sciences - March 8, 2017 Category: Neurology Authors: Aidonio Fiolaki, Aristeidis H Katsanos, Athanassios P Kyritsis, Styliani Papadaki, Maria Kosmidou, Iraklis C Moschonas, Alexandros D. Tselepis, Sotirios Giannopoulos Source Type: research

Clopidogrel and ischemic stroke outcomes by smoking status: Smoker's paradox?
Active smokers with myocardial infarction were shown to have enhanced benefit with clopidogrel compared with aspirin. Whether this “paradox” exists in ischemic stroke patients is unknown. We aimed to investigate whether smoking status has a differential impact on the efficacy of clopidogrel vs. aspirin in patients with non-cardioembolic strokes.
Source: Journal of the Neurological Sciences - December 16, 2016 Category: Neurology Authors: Qian Zhang, Yuan Wang, Haiqing Song, Chengbei Hou, Qingyu Cao, Kai Dong, Xiaoqin Huang, Wuwei Feng, Bruce Ovbiagele, Moli Wang, Xunming Ji Source Type: research

Reply to effect of CYP2C19*2 and *3 on clinical outcome in ischemic stroke patients treated with Clopidogrel
We read with great interest the recent publication of Wang et al. [1] evaluating the relationship between CYP2C19 genotypes with nonfatal ischemic stroke, myocardial infarction, or vascular death. The striking finding of this study was that the presence of CYP2C19 loss of function (LOF) alleles may increase the recurrent risk of ischemic events. The polymorphisms of CYP2C19 may be predictors of poor functional outcome of patients without stent and the effect may be weakened by time [1]. Similarly, the authors recently demonstrated that in patients with transient ischemic attack (TIA) or minor stroke who can be treated with...
Source: Journal of the Neurological Sciences - October 31, 2016 Category: Neurology Authors: Demetrios Moris, Chris Bakoyiannis, Georgios Karaolanis, Sotirios Georgopoulos Tags: Letter to the Editor Source Type: research

Effect of CYP2C19*2 and *3 on clinical outcome in ischemic stroke patients treated with clopidogrel
Despite clopidogrel has been widely applied to patients with ischemic stroke combined with aspirin, decreased metabolic activation of clopidogrel still occurs because of genetic variations in CYP2C19.
Source: Journal of the Neurological Sciences - August 13, 2016 Category: Neurology Authors: Yingting Wang, Huan Cai, Guoqing Zhou, Zhizhong Zhang, Xinfeng Liu Source Type: research

The curative effect comparison of two kinds of therapeutic regimens on decreasing the relative intensity of microembolic signal in CLAIR trial
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). Thus, we compared the effects of clopidogrel and aspirin with aspirin alone on MES intensity using TCD.
Source: Journal of the Neurological Sciences - May 20, 2016 Category: Neurology Authors: Q.Q. Deng, J. Tang, C. Chen, H. Markus, Y.N. Huang, H. Zhao, D. Ratanakorn, K.S.L. Wong, J.H. Fu Source Type: research

Implications of aspirin biochemistry in the pathobiology of ischemic cerebrovascular disease
I have read, with great interest, a recently published article in the Journal of Neurological Sciences by Li et al. titled ‘The efficacy and safety of aspirin plus dipyridamole versus aspirin in secondary prevention following TIA or stroke: A meta-analysis of randomized controlled trials’ . The authors performed a meta-analysis of five randomized controlled trials (RCT) comparing combined aspirin and clopidogrel dual antiplatelet therapy (DAT) to aspirin monotherapy (AM) for secondary stroke prevention in symptomatic patients. The number of patients in each treatment arm was similar with 4318 patients in the DAT cohort...
Source: Journal of the Neurological Sciences - October 21, 2013 Category: Neurology Authors: Dale Ding Tags: Letters to the Editor Source Type: research

The efficacy and safety of aspirin plus dipyridamole versus aspirin in secondary prevention following TIA or stroke: A meta-analysis of randomized controlled trials
Conclusions: Aspirin plus dipyridamole combination therapy was beneficial in reducing the recurrence of stroke, and did not increase the bleeding event. Hence, aspirin plus dipyridamole combination therapy is effective and safe for the secondary prevention of stroke.
Source: Journal of the Neurological Sciences - July 19, 2013 Category: Neurology Authors: Xia Li, Guoyu Zhou, Xueying Zhou, Shengnian Zhou Tags: Original Articles Source Type: research