Antiplatelet Therapy in Stroke Prevention: Present and Future

Caplan, Louis R.

doi:10.1159/000090356

Cited by 17 publications

(12 citation statements)

References 98 publications

(81 reference statements)

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“…In particular, the more favorable hepatic and hematologic profile of clopidogrel may allow for the elimination of routine laboratory testing in most patients when initiating antiplatelet therapy. In separate studies, both agents conferred superior efficacy to aspirin [7, 9] but our study was not sufficiently powered to determine definitively that clopidogrel had the same efficacy as ticlopidine. However, based on the safety advantage observed in this study, clopidogrel should be considered the preferred choice for Japanese patients with a history of noncardioembolic ischemic stroke.…”

Section: Discussionmentioning

confidence: 97%

“…Peptic ulceration, gastritis, and gastrointestinal bleeding are common adverse events associated with aspirin – but not ticlopidine – therapy. Ticlopidine has a relatively high incidence of side effects, especially diarrhea and rash, and severe but reversible neutropenia (<1% of patients) [8, 9]. Although ticlopidine is more effective than aspirin in preventing recurrence of stroke, the risk of side effects is greater [8].…”

Section: Introductionmentioning

confidence: 99%

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A Randomized, Double-Blind Study Comparing the Safety and Efficacy of Clopidogrel versus Ticlopidine in Japanese Patients with Noncardioembolic Cerebral Infarction

Fukuuchi

Tohgi²,

Okudera³

et al. 2007

Cerebrovasc Dis

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Background: Patients treated with ticlopidine require careful hematologic monitoring. Clopidogrel may have greater tolerability. However, no direct comparison of these two drugs has been reported and evidence of improved safety with clopidogrel is not yet established in the Japanese population. A comparison of both agents was therefore conducted in Japanese stroke patients. Methods: Patients with noncardioembolic cerebral infarction were randomized to clopidogrel 75 mg or ticlopidine 200 mg once daily for 52 weeks. The primary endpoint was safety; the major secondary endpoint was the incidence of vascular events.Results: Clopidogrel was associated with significantly fewer safety events than ticlopidine (7.0 versus 15.1%; p < 0.001) and no significant difference in efficacy between the two treatments was seen [hazard ratio 0.977 (95% confidence interval: 0.488–1.957)].Conclusions: In Japanese stroke patients, clopidogrel 75 mg is better tolerated than ticlopidine 200 mg once daily.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

A Randomized, Double-Blind Study Comparing the Safety and Efficacy of Clopidogrel versus Ticlopidine in Japanese Patients with Noncardioembolic Cerebral Infarction

Fukuuchi

Tohgi²,

Okudera³

et al. 2007

Cerebrovasc Dis

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“…The cardiogenic emboli are usually large and rich in red blood cells, so-called red thrombi [38]. These bulky and dense emboli could cause ‘bunchwise’ occlusion of multiple lenticulostriate arteries, resulting in a large striatocapsular infarction.…”

Section: Discussionmentioning

confidence: 99%

Can We Discriminate Stroke Mechanisms by Analyzing the Infarct Patterns in the Striatocapsular Region?

Lee

Oh²,

Roh³

et al. 2008

Eur Neurol

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Background and Aims: The aims of our study were to elucidate the differences in the distribution of acute middle cerebral artery (MCA) infarctions involving the striatocapsular region and to compare those following embolic striatocapsular infarctions with those originating from MCA disease (MCAD). Methods: We prospectively enrolled patients with acute large infarcts located in the lenticulostriate artery territory. Brain coronal diffusion-weighted imaging (DWI) and magnetic resonance angiography were carried out in all patients. The types of infarct distribution were divided into 3 categories: (1) dominant in the distal territory (DD), (2) distributed equally between the distal and proximal territories (DE) and (3) dominant in the proximal territory. Stroke mechanisms were classified into stroke from proximal embolism, MCAD and stroke of undetermined etiology. Results: A total of 71 patients were recruited. Proximal embolic sources were significantly more prevalent in patients with a DE lesion, but symptomatic MCA stenoses were more common in patients with a DD lesion than in those with a DE lesion. Conclusion: These results suggest that the dominant area of striatocapsular infarctions on coronal DWI can be an important clue for stroke etiology.

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“…The use of oral antithrombotic agents, namely oral anticoagulant and antiplatelet drugs, is widespread for the prevention of various arteriosclerotic events, including stroke and certain cardiovascular diseases [1, 2]. Of the various antithrombotic agents, warfarin increases the risk and worsens the outcomes of intracerebral hemorrhage (ICH) [3, 4].…”

Section: Introductionmentioning

confidence: 99%

Antithrombotic Therapy and Predilection for Cerebellar Hemorrhage

Toyoda¹,

Okada²,

Ibayashi

et al. 2006

Cerebrovasc Dis

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Background: With the recent increase in the use of antithrombotic therapy, intracerebral hemorrhage (ICH) has been found to be a common complication. We determined whether the use of oral antithrombotic therapy and the patients’ preexisting comorbidities were predictive of cerebellar hemorrhage (CH; previously reported to be associated with anticoagulants) as compared to other ICH, and whether antithrombotic therapy affected the clinical severity of CH. Methods: A study of 327 consecutive patients hospitalized in our institute within 3 days after the onset of ICH, including 38 patients with a CH. Results: CH accounted for 12% of all ICH, 75% of which occurred in patients on warfarin therapy with an international normalized ratio (INR) for prothrombin time >2.5 (p < 0.0001), and 33% of which occurred in patients on ticlopidine therapy (p = 0.017). Warfarin therapy with an INR >2.5 and high blood glucose on admission were independently predictive of CH as compared to other ICH. In addition, previous ischemic stroke (p = 0.002) and heart diseases (p = 0.018) were more prevalent in patients with CH than in those with other ICH. The number of major arteriosclerotic comorbidities and risk factors was also independently predictive of CH risk. Conclusions: We confirmed that warfarin therapy with an INR >2.5 is associated with CH. Patients with CH frequently had arteriosclerotic comorbidities requiring antithrombotic therapy that can complicate their acute management.

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Antiplatelet Therapy in Stroke Prevention: Present and Future

Cited by 17 publications

References 98 publications

A Randomized, Double-Blind Study Comparing the Safety and Efficacy of Clopidogrel versus Ticlopidine in Japanese Patients with Noncardioembolic Cerebral Infarction

A Randomized, Double-Blind Study Comparing the Safety and Efficacy of Clopidogrel versus Ticlopidine in Japanese Patients with Noncardioembolic Cerebral Infarction

Can We Discriminate Stroke Mechanisms by Analyzing the Infarct Patterns in the Striatocapsular Region?

Antithrombotic Therapy and Predilection for Cerebellar Hemorrhage

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