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Heart Disorders Message Board

Heart Disorders Board Index

I believe Lenin was getting into ischemic stroke and carotid stenosis, etc. and the efficacy of clopidogrel and aspirin for dual therapy. The CURE and CAPRIE trials support dual to therapy to those patients presenting NSTE (non-ST segment elevation... on EKG) and unstable angina. ST elevation indicates an infarcted area. Dual therapy to prevent restenosis after DES is recommended for a year.

The CARESS trial relates to dual antiplatelet therapy in the secondary prevention of stroke (large-vessel atherosclerorsis during the acute stage) is more effective in a selected group.

MATCH trial is more inclusive (all types of ischemic stroke) and found no additional benefit of aspirin and clop over clop alone

The basis for results of MATCH are asymptomatic microembolic (tiny clots) signals (MES) detected by transcrania Doppler ultrasound(TCD) are markers for stroke and transient ischemic attack (TIA's) and the randomized study, with intent to treat analysis, show 43.8% of dual therapy had positive MES on day 7 compared to 72.7% of monotherapy. Doppler MES detection is a feasible method to evaluate the efficacy of antiplatelet.

Longer term use of clop is not anymore risky than aspirin are the conclusions of all test that I have read.

[B]"In patients with of the carotid artery stenosis of more than 70%, carotid endarterectomy remains the first choice for treatment, although treatment is often delayed due to resource limitations or surgical risks. Aspirin is the mainstay of antithrombotic medication in the secondary prevention of microembolic stroke and TIA where carotid stenosis is 50% or less. However, according to the current authors, recent studies suggest that the risk of early recurrent stroke in patients with minor stroke or TIA may be as high as 8% to 12% at 7 days, and aspirin monotherapy may be inadequate to address this risk. Combination antiplatelet therapy is increasingly used in ischemic heart disease. For example, the combination of clopidogrel and aspirin has been shown to be more efficacious than aspirin alone for secondary prevention of acute coronary syndrome. According to the current authors, there is limited evidence for the efficacy of combination antiplatelet therapy for stroke prevention, and no international study has examined the use of MES frequency or detection using TCD to evaluate antiplatelet efficacy".[/B]

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