By Richard C Becker, Frederick A Spencer
Stroke is the most typical explanation for grownup mortality within the usa. Antithrombotic brokers shape the mainstay of stroke prevention. Aspirin produces a modest aid within the hazard of moment stroke and brief ischemic assault (TIA, mini-stroke) and is extensively urged for preliminary remedy. The thienopyridines (Ticlid) and clopodogrel (Plavix) are possible choices for secondary prevention in sufferers who don't reply to or can't take aspirin. they're not more powerful than aspirin and feature been linked to thrombotic thrombocytopenic purpura. the mix of aspirin and extended-release dipyridamole (Aggrenox) has a number of mechanisms of motion and an additive impact on lowering stroke danger in comparison with both agent on my own. A 2-fold bring up in probability relief and favorable safeguard profile recommend that the combo can function first-line prophylaxis opposed to a moment stroke. This quantity, as a part of the Oxford American Pocket Note sequence, offers the clinician wtih updated info at the guidance, and healing innovations in recurrent stroke/TIA prevention. beneficial good points contain remedy algorithms, illustrations, medicine tables, charts and figures to allow either the professional and the first supplier to make sure the simplest strategies to their sufferers as a way to hinder the reocurrence of stroke/TIA.
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Additional info for Antithrombotic Therapy in Prevention of Ischemic Stroke
Gorelick PB, Richardson D, Kelly M, et al. Aspirin and ticlopidine for prevention of recurrent stroke in black patients: a randomized trial. JAMA 2003;289:2947–57. 37. Ticlopidine Aspirin Stroke Study Group. Ticlopidine versus aspirin for stroke prevention: on-treatment results from the ticlopidine aspirin stroke study. J Stroke Cerebrovasc Dis 1993; 3:168–76. 38. Bennett CL, Weinberg PD, Rozenberg-Ben-Dror K, et al. Thrombotic thrombocytopenic purpura associated with ticlopidine. A review of 60 cases.
There were no significant differences in this outcome in the two patient groups. DIPYRIDAMOLE, EXTENDED-RELEASE DIPYRIDAMOLE/ASPIRIN COMBINATION (AGGRENOX) Aggrenox is a combination platelet antagonist that includes aspirin (25 mg) and dipyridamole (200 mg extended-release preparation). It is typically taken twice daily. Mechanism of Action Aspirin’s mechanism of action has been discussed previously. Dipyridamole inhibits cyclic adenosine monophosphate (cAMP)-phosphodiesterase (PDE) and cyclic-39, 59-guanylate monophosphate (GMP)-PDE40 (see Fig.
Circ Res 1964;15:83–8. 41. Pettigrew LC. Antithrombotic drugs for secondary stroke prophylaxis. Pharmacotherapy 2001;21(4):452–63. 42. Eisert WG. Near-field amplification of antithrombotic effects of dipyridamole through vessel wall cells. Neurology 2001;57(5 Suppl 2):S20–3. 43. Diener HC, Cunha L, Forbes C, et al. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143:1–13. 44. ESPRIT Study Group, Halkes PH, van Gijn J, Kappelle LJ, et al.
Antithrombotic Therapy in Prevention of Ischemic Stroke by Richard C Becker, Frederick A Spencer