Danish very-low-dose aspirin after carotid endarterectomy trial.

Boysen, Gudrun; Sørensen, Per; Juhler, Marianne; Andersen, Andreas; Boas, J.; Olsen, Jørgen; Joensen, Poul

doi:10.1161/01.str.19.10.1211

Cited by 96 publications

(23 citation statements)

References 31 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More cost-effective management may be achieved by other means, such as identification and control of coexisting vascular risk factors, patient education as to symptoms of cerebral ischemia, and possibly by the use of antiplatelet agents whose role following endarterectomy needs to be further clarified [24, 25, 26, 40]. …”

Section: Discussionmentioning

confidence: 99%

Significance of Carotid Restenosis following Endarterectomy

Ganesan¹,

Côté²,

Mackey³

1998

Cerebrovasc Dis

View full text Add to dashboard Cite

Background and Purpose: The clinical significance of restenosis after carotid endarterectomy as detected by duplex ultrasound has not been clearly established. To address this problem, we retrospectively evaluated the experience at two university-affiliated hospitals. Methods: All charts of patients with carotid endarterectomies between June 1987 and April 1995 were reviewed. Inclusion required neurological assessment and postoperative duplex ultrasound. Exclusion was based on a known source of cardioembolic disease, or recent (<6 months) myocardial infarction. Primary clinical endpoints were ipsilateral transient ischemic attack (TIA) or ischemic stroke. Contributing vascular risk factors were also identified. The effect of restenosis on event-free survival was analyzed using life tables and Gehan-Wilcoxon rank sum tet. Logistic regression was used to identify independent risk factors for restenosis and vascular events. Results: One hundred and eighty-seven patients were identified who underwent a total of 207 endarterectomies. Mean follow-up was 30.4 ± 20.9 months during which a total of 64 vascular events, including 42 TIAs, 18 strokes, and 4 vascular deaths occurred. Of these 21 TIAs and 8 strokes were ipsilateral to the side of endarterectomy. Event rates were compared for patients with ipsilateral high- (≥50%) and low-grade (<50%) restenosis. These two groups were comparable in terms of baseline risk factors. There was no significant difference in vascular event rates (for either ipsilateral events or events in any vascular territory) between the group with high- and low-grade restenosis. Nor was any such difference in event rates shown for patients who showed ipsilateral progression of carotid disease on serial ultrasound. However, patients operated for symptomatic carotid disease had a significantly higher risk of neurological events (p = 0.035). Logistic regression failed to disclose any other risk factors that were independently predictive of either restenosis or vascular events during follow-up. Conclusion: This study does not show a difference in vascular event rates for higher grades of carotid restenosis after carotid endarterectomy. Routine surveillance with carotid ultrasound does not appear to identify patients at higher risk for postoperative cerebrovascular events.

show abstract

Section: Discussionmentioning

confidence: 99%

Significance of Carotid Restenosis following Endarterectomy

Ganesan¹,

Côté²,

Mackey³

1998

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…Some secondary prevention trials of ASA (alone, or in combination with dipyridamole) have included diabetic patients (table 1) [19,20,21,22,23]. However, these trials did not specifically assess the effect of antiplatelet therapy in subgroups of patients with DM.…”

Section: Antiplatelet Therapymentioning

confidence: 99%

Secondary Prevention of Stroke with Antiplatelet Agents in Patients with Diabetes mellitus

2005

View full text Add to dashboard Cite

The prevalence of diabetes mellitus (DM) varies from 1.2 to 13.3% in the general population. The most frequent is type 2 (non-insulin-dependent) DM, which constitutes 90–95% of all cases. DM increases the risk of cardiac disease, stroke, retinopathy, nephropathy, neuropathy and gangrene, and the disease is associated with an increased prevalence of other cardiovascular risk factors such as hypertension, hypercholesterolaemia, asymptomatic carotid artery disease, and obesity. The risk of stroke may be directly and indirectly increased by the presence of DM. Epidemiological data show that DM independently amplifies the risk of ischaemic stroke from 1.8- up to 6-fold, so that prevention of cardiovascular risk in diabetics is of utmost importance. The main goal is to control glycaemia, although it has never been shown to be beneficial in stroke patients. Other preventive strategies include antiplatelet treatment. The open-label Primary Prevention Project trial tested the efficacy of low-dose acetylsalicylic acid (ASA) in prevention of ischaemic events in high-risk patients, but failed to demonstrate a significant benefit of ASA in diabetic patients. However, in the CAPRIE trial, the benefit of clopidogrel was amplified in patients with DM versus those without DM in preventing ischaemic events. This difference was even more striking when comparing patients treated with insulin versus non-diabetics. Another trial – MATCH – tested the benefit of adding ASA to clopidogrel versus clopidogrel alone in the prevention of ischaemic events in high-risk cerebrovascular patients, two-thirds of whom had DM. Further research is needed to clarify the effects of different antiplatelet regimens in stroke prevention in diabetic patients, who should be considered as high vascular-risk patients.

show abstract

“…The stroke rate was not reported. A Danish trial 42 comparing very-low-dose aspirin (50 to 100 mg/d) with placebo reported no significant difference in survival. However, treatment was not begun until 1 to 12 weeks after surgery.…”

Section: Antiplatelet Therapymentioning

confidence: 99%