Magnitude and time course of platelet inhibition with Aggrenox® and Aspirin in patients after ischemic stroke: the AGgrenox versus Aspirin Therapy Evaluation (AGATE) trial

Serebruany, Victor L.; Malinin, Alex I.; Sane, David C.; Jilma, Bernd; Takserman, A.; Atar, Dan; Hennekens, Charles H.

doi:10.1016/j.ejphar.2004.07.114

Cited by 41 publications

(30 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25 Aspirin plus dipyridamole does augment platelet inhibition compared with aspirin alone and, as mentioned previously, may provide some clinical benefit in patients with ischemic stroke compared with aspirin alone. 26 In our study, only one patient was changed to aspirin plus dipyridamole. To date, higher dosages of aspirin, adding clopidogrel, or increasing the dosage of clopidogrel have not yielded any clinical benefit in preventing recurrent stroke and, moreover, are associated with an increased risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Using a Platelet Function-Guided Approach for Secondary Prevention in Patients With Ischemic Stroke or Transient Ischemic Attack

Depta

Fowler

Novak

et al. 2012

Stroke

View full text Add to dashboard Cite

Background and Purpose-Antiplatelet therapy nonresponse is associated with worse clinical outcomes. We studied the clinical outcomes associated with platelet function-guided modifications in antiplatelet therapy in patients with ischemic stroke or transient ischemic attack. Methods-From January 2005 to August 2007, 324 patients with ischemic stroke underwent platelet function testing using platelet aggregometry. Aspirin nonresponse was defined as a mean platelet aggregation Ն20% with 0.5 mg/mL arachidonic acid and/or Ն70% with 5 mol/L adenosine diphosphate. Clopidogrel nonresponse was defined as a mean platelet aggregation Ն40% with 5 mol/L adenosine diphosphate. A modification was any increase in antiplatelet therapy occurring after testing. Clinical outcomes were compared between patients with and without platelet function-guided antiplatelet therapy modifications using univariate and propensity score-adjusted analyses. Results-In patients with ischemic stroke or transient ischemic attack, 43% (nϭ128) and 35% (nϭ54) were nonresponders to aspirin and clopidogrel, respectively. After platelet function testing, antiplatelet therapy was increased in 23% of patients (nϭ73). After propensity score matching (nϭ61 in each group), antiplatelet therapy modification was associated with significantly increased rates of death, ischemic events, or bleeding (hazard ratio, 2.24; 95% CI, 1.12-4.47; Pϭ0.02) compared with no modification in antiplatelet therapy and a trend toward increased bleeding (hazard ratio, 3.56; 95% CI, Pϭ0.05). No differences in ischemic events were observed. Conclusions-Platelet function-guided modification in antiplatelet therapy after an ischemic stroke or transient ischemic attack was associated with significantly higher rates of adverse clinical outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Using a Platelet Function-Guided Approach for Secondary Prevention in Patients With Ischemic Stroke or Transient Ischemic Attack

Depta

Fowler

Novak

et al. 2012

Stroke

View full text Add to dashboard Cite

show abstract

“…A recent study of patients recovering from ischemic stroke showed that Ͼ10% were noncompliant with aspirin. 44 Clinical implications of aspirin noncompliance have been studied in patients with prior myocardial infarction. Noncompliance, detected by serum TX assay and on interview, occurred in 16% of the population and was associated with 4-fold higher incidence of death, reinfarction, or rehospitalization at 12 months of follow-up.…”

Section: Drug Compliancementioning

confidence: 99%

Variable Platelet Response to Aspirin and Clopidogrel in Atherothrombotic Disease

2007

View full text Add to dashboard Cite

“…Most definitions of HTPR are 'cross-sectional, case-control' definitions whereby patients' results at a single time point are compared with those obtained from a group of healthy controls or the manufacturer's normal range. Very few robust, prospective, 'longitudinal studies' in CVD, in which the same patients are tested before and after starting or changing antiplatelet therapy have been performed to date (see below) [26][27][28][29][30][31][32][33]. Longitudinal definitions of HTPR in CVD patients commencing or changing antiplatelet therapy have the potential to provide more clinically meaningful information than traditional cross-sectional definitions of HTPR [26].…”

Section: Introductionmentioning

confidence: 99%

“…A pilot randomized trial showed that 30 days treatment with aspirin-dipyridamole combination therapy may lead to enhanced inhibition of platelet function compared with aspirin alone in Japanese patients with ischaemic CVD [33]. A further longitudinal, randomized study comprehensively assessed platelet activation and function in type II diabetic patients in the late stages after TIA, allocated to receive aspirin-dipyridamole combination therapy, clopidogrel monotherapy or aspirin-clopidogrel combination therapy [29].…”

mentioning

confidence: 99%

Platelet function testing in transient ischaemic attack and ischaemic stroke: A comprehensive systematic review of the literature

et al. 2015

View full text Add to dashboard Cite

The majority of patients with ischaemic cerebrovascular disease (CVD) are not protected from further vascular events with antiplatelet therapy. Measurement of inhibition of platelet function ex vivo on antiplatelet therapy, using laboratory tests that correlate with the clinical effectiveness of these agents, would potentially enable physicians to tailor antiplatelet therapy to suit individuals. A systematic review of the literature was performed to collate all available data on ex vivo platelet function/reactivity in CVD patients, especially those treated with aspirin, dipyridamole or clopidogrel. Particular emphasis was paid to information from commonly available whole blood platelet function analysers (PFA-100 Õ , VerifyNow Õ and Multiplate Õ ). Data on pharmacogenetic mechanisms potentially influencing high on-treatment platelet reactivity (HTPR) on antiplatelet therapy in CVD were reviewed. Two-hundred forty-nine potentially relevant articles were identified; 93 manuscripts met criteria for inclusion. The prevalence of ex vivo HTPR in CVD varies between 3-62% with aspirin monotherapy, 8-61% with clopidogrel monotherapy and 56-59% when dipyridamole is added to aspirin in the early, subacute or late phases after TIA/stroke onset. The prevalence of HTPR on aspirin was higher on the PFA-100 than on the VerifyNow in one study (p50.001). Furthermore, the prevalence of HTPR on aspirin was lower when one used 'novel longitudinal' rather than 'cross-sectional, case-control' definitions of HTPR on the PFA early after TIA or stroke (p ¼ 0.003; 1 study). Studies assessing the influence of genetic polymorphisms on HTPR in CVD patients are limited, and need validation in large multicentre studies. Available data illustrate that an important proportion of CVD patients have ex vivo HTPR on their prescribed antiplatelet regimen, and that the prevalence varies depending on the definition and assay used. Large, adequately-sized, prospective multicentre collaborative studies are urgently needed to determine whether comprehensive assessment of HTPR at high and low shear stress with a range of user-friendly whole blood platelet function testing platforms, in conjunction with pharmacogenetic data, improves our ability to predict the risk of recurrent vascular events in CVD patients, and thus enhance secondary prevention following TIA or ischaemic stroke.

show abstract

Magnitude and time course of platelet inhibition with Aggrenox® and Aspirin in patients after ischemic stroke: the AGgrenox versus Aspirin Therapy Evaluation (AGATE) trial

Cited by 41 publications

References 42 publications

Clinical Outcomes Using a Platelet Function-Guided Approach for Secondary Prevention in Patients With Ischemic Stroke or Transient Ischemic Attack

Clinical Outcomes Using a Platelet Function-Guided Approach for Secondary Prevention in Patients With Ischemic Stroke or Transient Ischemic Attack

Variable Platelet Response to Aspirin and Clopidogrel in Atherothrombotic Disease

Platelet function testing in transient ischaemic attack and ischaemic stroke: A comprehensive systematic review of the literature

Contact Info

Product

Resources

About