Randomised Trial of Pentoxifylline Versus Acetylsalicylic Acid Plus Dipyridamole in Preventing Transient Ischaemic Attacks

Herskovits, E; Famulari, A.; Tamaroff, L.; González, Ana-Maria; Vázquez, A.; Smud, R; Fraiman, H.; Vila, José Henrique Andrade; Matera, Vicente

doi:10.1016/s0140-6736(81)91732-3

Cited by 39 publications

(6 citation statements)

References 8 publications

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“…There was no signi®cant difference between studies published before 1980 (OR 0.65, 95% CI 0.5±0.9, P = 0.04, heterogeneity P = 0.09; seven studies) and studies published after 1980 (OR 0.69, 95% CI 0.6±0.8, P < 0.00001, heterogeneity P = 0.59; 20 studies). The ®ndings in the three largest studies (OR 0.66, 95% CI 0.5±0.8, P = 0.00003, heterogeneity P = 0.23) (ESPS Group, 1990;Sivenius et al, 1991;Grotta et al, 1992;Cillessen et al, 1993) did not differ from the remainder (OR 0.71, 95% CI 0.6±0.9, P = 0.003, heterogeneity P = 0.45), and the results were also consistent Baker, 1971;Baumgartner et al, 1989;Biller et al, 1989;Haerer et al, 1977;Herskovits et al, 1981a;Lo Âpez-Gasto Ân et al, 1994;Marshall and Reynolds, 1965;Olsson et al, 1980;Olsson et al, 1976;Putman and Adams, 1985;Reuther et al, 1980;Siekert et al, 1961;Tsuda et al, 1983 None Ischaemic stroke 17 Baker et al, 1968;Baker, 1971;Biller et al, 1989;Bousser et al, 1983;Bure Ân and Ygge, 1981;Cartlidge et al, 1977;Cillessen et al, 1993;Friedman et al, 1969;Haerer et al, 1977;Larsen et al, 1990;Lo Âpez-Gasto Ân et al, 1994;Muuronen and Kaste, 1982;Olsson et al, 1980;Omae, 1976;Ostfeld et al, 1973;Siekert et al, 1961;Whisnant et al, 1978 All studies, except Italian Multicenter Study Stroke 24 Acheson 1971;Acheson and Hutchinson, 1964;Baker et al, 1966;…”

Section: Risk Of Strokesupporting

confidence: 57%

Prognosis of vertebrobasilar transient ischaemic attack and minor stroke

Floßmann

2003

Brain

206

106

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Vertebrobasilar (VB) territory transient ischaemic attacks (TIAs) and minor strokes are perceived to have a better prognosis than carotid territory events, and are sometimes managed less aggressively. However, this notion stems mainly from a few small studies in the 1960s and 1970s, and has not been systematically tested. We therefore identified all published studies of prognosis after TIA or minor stroke using MEDLINE and EMBASE, and hand-searching reference lists and relevant journals. In addition, we attempted to include all available individual patient data (IPD) from studies that had not published outcome data by territory of presenting event. Odds of recurrent events were calculated within studies and combined by fixed-effects meta-analysis. Heterogeneity between studies was calculated using the chi2 method. We stratified the analysis by time interval between presenting event and inclusion in study, and by study setting (population-based, published hospital-based and unpublished hospital-based). Publication bias was tested for by linear regression of the standard normal deviate against precision. Eight hundred and twenty abstracts were reviewed, and 304 papers were considered in detail. Of these, 43 studies representing 36 independent cohorts (12,196 patients) reported outcomes by territory of presenting event. IPD from five studies (4643 patients) were also included. The following results compare relative risks of VB with carotid events. Studies including the acute phase (up to 7 days) after the presenting event found a higher relative risk of subsequent stroke in patients with VB events [odds ratio (OR) 1.47, 95% confidence interval (CI) 1.1-2.0, P = 0.014]. Conversely, studies mainly recruiting after the acute phase found a lower relative risk (OR 0.74, 95% CI 0.7-0.8, P = 0.00001). In published hospital-based studies, the risk of recurrent stroke was lower for patients presenting with VB events (OR 0.68, 95% CI 0.6-0.8, P< 0.00001). However, there was no difference in hospital-based IPD (OR 1.02, 95% CI 0.8-1.3, P = 0.91). Moreover, in population-based studies, patients with VB events had a higher risk of stroke (OR 1.48, 95% CI 1.1-2.0, P = 0.025). There was no within-stratum heterogeneity. There was no difference in the risk of fatal stroke (OR 1.04, 95% CI 0.8-1.4, P = 0.90). Therefore, we found no evidence that patients presenting with VB events have a lower risk of subsequent stroke or death compared with patients presenting with carotid TIA or minor stroke. Indeed, their risk of stroke is probably higher in the acute phase. Patients with VB events require active preventive treatment.

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Section: Risk Of Strokesupporting

confidence: 57%

Prognosis of vertebrobasilar transient ischaemic attack and minor stroke

Floßmann

2003

Brain

206

106

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“…Increased platelet aggregation, both in TIAs and in major strokes, has been reported by some investigators [10,14], whereas others were able to confirm these findings in patients with TIAs but not in those affected by cerebral infarction [7]. These last findings also agree with the considerable discordances among several clinical trials [1][2][3]5,6,[8][9][10]12,13,16] concerned with the prevention of recurrence TIAS and/or occurrence of ischemic strokes in patients subjected to antiplatelet treatments. Moreover, some reports suggest that no prediction of the risk of subsequent stroke or death is provided by the data from in vitro measurements of platelet aggregation [15].…”

Section: Discussionsupporting

confidence: 67%

A multiparametric index of platelet in vitro aggregation in cerebrovascular disease

Gazzaniga

Ferroni

Minà³

et al. 1987

Ital J Neuro Sci

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148 patients with various forms of cerebrovascular disease (CVD) were studied by means of a multiparametric analysis of in vitro platelet aggregation, based on the following six parameters: ADP and epinephrine primary and secondary aggregation thresholds and percent maximum aggregation induced by optimal concentrations of ADP and epinephrine. These patients were assigned to four study groups, according to clinical diagnosis supported by CT scan, of transient ischemic attack and reversible neurological deficit (TIA-RIND), or completed stroke, in the presence or absence respectively of antiplatelet medical treatment at the time of the study. A statistically significant increase of the in vitro platelet aggregation was found in 44.4% of the untreated TIA-RIND patients and in 33.9% of the untreated stroke patients. However this last group showed a higher percentage of very marked hyperaggregation. Differences between the two treated study groups and controls were not significant. No difference was found in collagen- and ristocetin-induced aggregation between the patient groups and the controls.

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“…(3) risk factor control, and (4) ad verse effects. The first 63 patients were followed up in this way for 12 months [25]; the second series of 62 patients were followed up for 6 months only (this represents the period during which most ischemic relapses occur). The first 6-month period only was taken as the basis for statistical evaluation for all patients described in this paper.…”

Section: Methodsmentioning

confidence: 99%

“…In line with the above considerations, pre ventive therapy first took the form of antico agulants [11][12][13][14][15][16] and more recently drugs which inhibit platelet aggregation [17][18][19][20][21][22][23][24], In a previous paper [25] we reported our prelim inary experiences with pentoxifylline (PTX), a drug with hemorheological, antiplatelet and antithrombotic properties, in comparison with an antiplatelet combination of acetylsalicylic acid and dipyridamole (ASA+D). The present study shows the results of such treat ment in 138 patients during 6 months follow up after the first ischemic event.…”

Section: Introductionmentioning

confidence: 99%

Preventive Treatment of Cerebral Transient Ischemia: Comparative Randomized Trial of Pentoxifylline versus Conventional Antiaggregants

Herskovits¹,

Famulari²,

Tamaroff³

et al. 1985

Eur Neurol

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A comparative study of the prevention of recurrences of cerebral transient ischemic attacks during a 6-month observation period was conducted in 73 patients treated with a combination of acetylsalicylic acid and dipyridamole (ASAD, 1,050 mg + 150 mg/day) and in 65 patients treated with pentoxifylline (PTX 1,200 mg/day, Trental® 400 t.d.s). The patients were randomly assigned to the treatments. Risk factor analysis showed high prevalence of arterial hypertension, hyperlipidemia and smoking in these patients. The two groups were matched in terms of age, sex, blood pressure and site of TIA origin (carotid 63% in the ASAD, 65% in the PTX group). 23 ASAD patients and 9 PTX patients suffered a recurrence. There were 4 nonfatal stroke events with ASAD and 2 with PTX. 80 recurrent TIAs were recorded in 19 ASAD patients compared with 19 such episodes in 9 PTX subjects. The morbidity rates (life table analysis) were significantly lower (p < 0.05) in the PTX group. The results of the study point to a preventive effect of PTX in terms of the reduction in TIA recurrences.

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Randomised Trial of Pentoxifylline Versus Acetylsalicylic Acid Plus Dipyridamole in Preventing Transient Ischaemic Attacks

Cited by 39 publications

References 8 publications

Prognosis of vertebrobasilar transient ischaemic attack and minor stroke

Prognosis of vertebrobasilar transient ischaemic attack and minor stroke

A multiparametric index of platelet in vitro aggregation in cerebrovascular disease

Preventive Treatment of Cerebral Transient Ischemia: Comparative Randomized Trial of Pentoxifylline versus Conventional Antiaggregants

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