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International Stroke Conference 2012: Clopidogrel/aspirin not effective for prevention of recurrent stroke
The antiplatelet arm of The Secondary Prevention of Small Subcortical Stroke (SPS3) study was halted in July 2011 due to reasons of safety and futility, according to principal investigator Oscar R. Benavente, MD, FRCP (C), professor of neurology at Canada's University of British Columbia in Vancouver, British Columbia.
The antiplatelet arm of The Secondary Prevention of Small Subcortical Stroke (SPS3) study was halted in July 2011 due to reasons of safety and futility, according to principal investigator Oscar R. Benavente, MD, FRCP (C), professor of neurology at Canada's University of British Columbia in Vancouver, British Columbia.
He presented the preliminary results of the trial at the International Stroke Conference 2012 in New Orleans.
Dr Benavente and researchers are looking for effective strategies to reduce recurrent stroke, cognitive decline, and major vascular events. Small subcortical strokes occur when blood flow in the small arteries to the subcortical areas of the brain get blocked. Although they account for more than a quarter of brain infarcts and are the most common cause of vascular dementia, no clinical trial has focused on this subtype, he said.
Results indicated that dual antiplatelet therapy was not more effective than aspirin alone. Annual risk for recurrent stroke for patients in the aspirin-only group was 2.7% versus 2.5% for patients in the dual therapy group. Compared with the aspirin-only group, the risk of bleeding nearly doubled for patients assigned to dual therapy.
Similarly, the annual risk of death for patients assigned to dual therapy was much higher than that for patients taking aspirin alone (2.1% versus 1.4%). This was surprising and Dr Benavente said they are continuing to analyze this finding.
"Certainly these results do not support the use of combination therapy of aspirin plus clopidigrel for long-term secondary stroke prevention in patients with lacunar strokes," he said.
The blood pressure arm of the trial, in which the investigators are examining whether blood pressure control may be associated with fewer recurrent strokes, is continuing. Patients with hypertension have been randomly assigned to 1 of 2 groups of blood pressure controls: below 130 mmHg of systolic pressure or between 130 mmHg and 149 mmHg. Dr Benavente said the trial will be completed in April and delayed results are expected later this summer.
Coalition promotes important acetaminophen dosing reminders
November 18th 2014It may come as a surprise that each year Americans catch approximately 1 billion colds, and the Centers for Disease Control and Prevention estimates that as many as 20% get the flu. This cold and flu season, 7 in 10 patients will reach for an over-the-counter (OTC) medicine to treat their coughs, stuffy noses, and sniffles. It’s an important time of the year to remind patients to double check their medicine labels so they don’t double up on medicines containing acetaminophen.
Support consumer access to specialty medications through value-based insurance design
June 30th 2014The driving force behind consumer cost-sharing provisions for specialty medications is the acquisition cost and not clinical value. This appears to be true for almost all public and private health plans, says a new report from researchers at the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC).
Management of antipsychotic medication polypharmacy
June 13th 2013Within our healthcare-driven society, the increase in the identification and diagnosis of mental illnesses has led to a proportional increase in the prescribing of psychotropic medications. The prevalence of mental illnesses and subsequent treatment approaches may employ monotherapy as first-line treatment, but in many cases the use of combination of therapy can occur, leading to polypharmacy.1 Polypharmacy can be defined in several ways but it generally recognized as the use of multiple medications by one patient and the most common definition is the concurrent use of five more medications. The presence of polyharmacy has the potential to contribute to non-compliance, drug-drug interactions, medication errors, adverse events, or poor quality of life.
Medical innovation improves outcomes
June 12th 2013I have been diagnosed with stage 4 cancer of the pancreas, a disease that’s long been considered not just incurable, but almost impossible to treat-a recalcitrant disease that some practitioners feel has given oncology a bad name. I was told my life would be measured in weeks.
