Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke

Sacco, Ralph L.; Diener, Hans‐Christoph; Yusuf, Salim; Cotton, Daniel; Ôunpuu, Stephanie; Lawton, William A.; Yu, Amy Y.X.; Martin, Renée; Albers, Gregory W.; Bath, Philip M.W.; Bornstein, Natan M.; Chan, Bernard P.L.; Chen, Sien-Tsong; Cunha, Luı́s; Dahlöf, Björn; Keyser, Jacques De; Donnan, Geoffrey A.; Estol, Conrado J.; Gorelick, Philip B.; Gu, Vivian; Hermansson, Karin; Hilbrich, Lutz; Kaste, Markku; Lü, Chuan-Zhen; Machnig, Thomas; Пайс, Прем; Roberts, Robin S.; Skvortsova, Veronika; Teal, Philip; Toni, Danilo; Vandermaelen, Cam P.; Voigt, Thor; Weber, Michael A.; Yoon, Byung‐Woo

doi:10.1056/nejmoa0805002

Cited by 874 publications

(572 citation statements)

References 30 publications

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“…However, whether HUK, a commercially available kallikrein–kinin system regulating medicine, is efficient in preventing recurrent stroke has not been reported yet. Previous studies have demonstrated that antiplatelet agents, statins, warfarin, and diabetic agents could reduce risk of recurrent stroke for specific stroke patient (Adams et al., 2008; Prasad, Kaplan, & Passman, 2012; Rother & Crijns, 2010; Sacco et al., 2008). In this study, we firstly found that implementation of HUK during initial hospitalization after acute onset was effective for preventing recurrent stroke within 12 months.…”

Section: Discussionmentioning

confidence: 99%

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Han

Chen

Li³

et al. 2018

Brain and Behavior

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ObjectivesTo evaluate the efficacy of Human Urinary Kallidinogenase (HUK) for secondary stroke prevention in the treatment of acute ischemic stroke (AIS) patients.Materials and MethodsIn this retrospective study, from October 2016 to June 2017, 300 consecutive AIS patients were registered in our database. Among them, 145 patients received HUK treatment (HUK group), and 155 patients received basic treatment (control group). Basic treatment was administrated on all patients. 0.15 PNA unit of HUK injection plus 100 ml saline in intravenous infusion was performed in the HUK group, with once a day for 14 consecutive days. The rate of recurrent stroke and modified Rankin Scale (mRS) scores in two groups were analyzed 12 months after the treatment.ResultsNo difference was found in the age, gender, comorbidities, smoking history, and NIHSS scores between two groups before treatment (p > 0.05). 12 months after treatment, 10 patients in the HUK group (10.3%) and 26 patients in the control group (16.8%) got stroke recurrence at 12 months (p = 0.009). The mRS score of HUK group was significantly lower than that in the control group (2.3 ± 1.2 vs. 3.5 ± 1.4, p = 0.011).ConclusionHuman Urinary Kallidinogenase is able to reduce the risk of stroke recurrence and promote good recovery for AIS patients within 12 months.

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Section: Discussionmentioning

confidence: 99%

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Han

Chen

Li³

et al. 2018

Brain and Behavior

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“…Headache is a side effect of the drug dipyridamole. However, there is no reason to believe that dipyridamole is a cause of poorer prognosis and increased occurrence of complications since no such correlation has been found in previous studies (Sacco et al., 2008). …”

Section: Discussionmentioning

confidence: 99%

Codeine is associated with poor prognosis in acute stroke

2017

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BackgroundThe aim of this study was to investigate how the use of analgesics, sleeping drugs, and sedatives relates to prognosis and complications in stroke patients in the acute care phase (≤48 hr) after a stroke.Materials and MethodsPatients with ischemic stroke, hemorrhagic stroke, and transient ischemic attack were included. The study is based on gathering of data on medication from 921 patient records belonging to patients included in the Bergen NORSTROKE registry, 12.2009‐02.2012. In this database risk factors, stroke severity, etiology, and blood analyses were prospectively registered. We have retrospectively registered if patients received one drug or more from a list of analgesics, sleeping drugs, and sedatives within the first 48 hr after admission.ResultsIn total, 921 patients were included in the study, 408 females and 513 males. Mean age was 71.0 years. In total, 101 patients were given sleeping drugs, 97 patients sedatives and 140 patients analgesics. Of the group given analgesics, 90 patients were given codeine‐containing analgesics. Logistic regression analyses showed that codeine‐containing analgesics were associated with an increased occurrence of pneumonia (OR = 3.8, p < .001), stroke worsening (OR = 2.7, p = .001), and a higher mRS‐score (OR = 2, p = .024) day 7. The study did not show any relation between poorer prognosis or increased occurrence of complications and the use of other analgesics, sedatives and/or sleeping drugs.ConclusionUse of codeine‐containing analgesics is associated with a poorer short‐term prognosis and an increased occurrence of complications in the acute phase after a stroke. The highly significant findings suggest that codeine has a negative effect on acute stroke patients. The study reflects exploratory analyses and prospective studies are necessary to determine the background of the association observed in our study.

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“…The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) study is a randomized, doubleblind, noninferiority trial with a 2×2 factorial design comparing aspirin-ERDP (25/200 mg) twice daily with clopidogrel (75 mg) daily for prevention of recurrent stroke [35]. A total of 20,332 patients were followed-up for a mean of 2.5 years.…”

Section: Aspirin Plus Dypyridimole Vs Clopidogrelmentioning

confidence: 99%

“…In the subgroup analysis of the PRoFESS study, there was a trend of benefit of clopidogrel in comparison to aspirin-ERDP, with an event rate of stroke of 9.4% as compared with 10.5% in patients who were recruited after a large artery stroke [35]. The comparison in lacunar stroke indicated that the 2 drugs were similar (i.e., clopidogrel [8.2%] vs combined therapy [7.9%]).…”

Section: Large Vessel Atherosclerosismentioning

confidence: 99%

Antiplatelet Agents for Stroke Prevention

Yip

Benavente

2011

Neurotherapeutics

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Stroke is one of the leading causes of disability and death. Ischemic stroke is a syndrome with heterogeneous mechanisms and multiple etiologies, rather than a singularly defined disease. Approximately one third of ischemic strokes are preceded by another cerebrovascular ischemic event. Stroke survivors are at high risk of vascular events (i.e., cerebrovascular and cardiovascular events), particularly during the first several months after the ischemic event. The use of antiplatelet agents remains the fundamental component of secondary stroke prevention. Based on the available data, antiplatelet agents should be used for patients with noncardioembolic stroke. The use of combination therapy (aspirin plus clopidogrel) has not been proven to be effective or safe to use for prevention of early stroke recurrence or in long-term treatment. There is no convincing evidence that any of the available antiplatelet agents are superior for a given stroke subtype. Currently, the uses of aspirin, clopidogrel, or aspirin combined with extended release dipyridamole are all valid alternatives after an ischemic stroke or transient ischemic attack. However, to maximize the effects of these agents, the treatment should be initiated as early as possible and be continued on a lifelong basis.

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Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke

Cited by 874 publications

References 30 publications

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Codeine is associated with poor prognosis in acute stroke

Antiplatelet Agents for Stroke Prevention

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