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Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response . By Charlotte Lützhøft Rath, Niklas Rye Jørgensen and Troels Wienecke.

Se hela listan på aafp.org Se hela listan på ahajournals.org NICE technology appraisal TA210 recommends clopidogrel as the most cost-effective antiplatelet therapy for secondary prevention following ischaemic stroke [NICE, 2010b]. The Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events comparative trial (CAPRIE) randomized over 19 000 patients with stroke, MI, or peripheral vascular disease to aspirin 325 mg/day or clopidogrel 75 mg/day. Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response . By Charlotte Lützhøft Rath, Niklas Rye Jørgensen and Troels Wienecke. To our knowledge, this is the first report of clopidogrel use in pregnancy for secondary stroke prophylaxis.

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Aspirin combined with the antiplatelet drug clopidogrel is no better than aspirin alone for stroke prevention in people with a history of lacunar strokes, and the combination carries a greater risk of gastrointestinal bleeding, according to results of a trial funded by the National Institutes of Health. stroke (secondary prevention and aspirin) aspirin in secondary prevention of TIA: aspirin and secondary stroke prophylaxis in NRAF: aspirin post myocardial infarction: CHD (aspirin or clopidogrel) for people with an ongoing separate indication for anticoagulation post ACS: Secondary Stroke Prophylaxis with Clopidogrel Produces Sufficient Antiplatelet Response. Rath CL (1), Jørgensen NR (2), Wienecke T (3). Author information: (1)Neurovascular Centre, Dept. of Neurology, Zealand University Hospital, Denmark. Electronic address: clra@regionsjaelland.dk.

2010-08-01

Yet, a proportion of patients who receive antiplatelet therapy experience recurrent ischemic cerebrovascular events. 1 It has been proposed that insufficient platelet inhibition despite antiplatelet therapy might account for a proportion of those Clopidogrel.

Clopidogrel is a thienopyridine derivative chemically related to ticlopidine, which is superior to aspirin in stroke prevention 

To our knowledge, this is the first report of clopidogrel use in pregnancy for secondary stroke prophylaxis. clopidogrel have been compared to the effects of ASA in a randomized, controlled study involving over 19 000 patients. The diseases targeted for prevention were stroke, myocardial infarction, and fatal cardiovascular disease. After a followup of 1.9 years, the authors found a 0.5 per cent absolute difference favoring clopidogrel. PURPOSE: Clopidogrel is more effective than aspirin in preventing recurrent vascular events, but concerns about its cost-effectiveness have limited its use. We evaluated the cost-effectiveness of clopidogrel and aspirin as secondary prevention in patients with a prior myocardial infarction, a prior stroke, or peripheral arterial disease. Dual therapy with aspirin and clopidogrel may be initiated in secondary care for the first three months following ischaemic stroke or TIA due to severe  Clopidogrel is a thienopyridine derivative chemically related to ticlopidine, which is superior to aspirin in stroke prevention  Aspirin Plus Clopidogrel for Long-Term Secondary Stroke Prevention.

24 Clopidogrel 75 mg/d was compared with aspirin 325 mg/d, with a Conclusions- Results favor clopidogrel and aspirin/dipyridamole combination for long-term secondary prevention after noncardioembolic stroke or transient ischemic attack, regardless of patient characteristics. Aspirin/clopidogrel combination was associated with a significantly higher risk of major bleeding compared with other antiplatelet regimens. The non-inferiority of prasugrel to clopidogrel for the prevention of ischaemic stroke, myocardial infarction, and death from other vascular causes was not confirmed in Japanese patients with non-cardioembolic stroke. No safety concerns were identified.
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TRITON-TIMI 38 study NICE recommends clopidogrel as the most cost-effective antiplatelet for secondary prevention of stoke [ NICE, 2010a ], however, clopidogrel is not licensed for use after a TIA [ ABPI, 2018a ], so NICE recommends treatment with modified-release dipyridamole plus aspirin as the preferred treatment option for TIA [ NICE, 2010a ].
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Clopidogrel was restarted 12 hours postpartum without an incident. To our knowledge, this is the first report of clopidogrel use in pregnancy for secondary stroke prophylaxis.

Patients suffering a transient ischaemic attack (TIA) or ischaemic stroke (IS) have a high risk of recurrence. The inhibition of platelet function is effective in the reduction of secondary vascular events in patients with TIA or stroke.

In this study we assessed the safety and efficacy of clopidogrel versus aspirin in real‐world practice by using the Taiwan Stroke Registry. The American Heart Association/American Stroke Association and the American College of Chest Physicians have published guidelines that provide recommendations on antiplatelet therapy for secondary prevention of ischemic stroke. Aspirin, clopidogrel, and aspirin/extended-release dipyridamole are the most commonly used agents.