Saturday, December 12, 2009
Harrie clopidogrel aspirine
Medscape gastroenterology 12-12-09
Aspirin plus clopidogrel treatment has not been found to be beneficial in patients with recent ischemic stroke or atrial fibrillation.[9,10] In the MATCH trial, a nonsignificant reduction in major vascular events was observed when clopidogrel was added to aspirin (15.7%) versus clopidogrel alone (16.7%), with absolute risk reduction of 1% (95% CI –0.6 to 2.7) in patients with ischemic stroke or transient ischemic attack.[9] Conversely, the risk of major bleeding was increased in the dual antiplatelet group versus clopidogrel alone when administered for a mean of 18 months (2% vs 1%; p <>[10] The study was stopped on the recommendation of the Data Safety and Monitoring Board before the planned follow-up was completed because of the clear evidence of superiority of oral anticoagulation. A significant reduction in the number of a first occurrence of stroke, non–central nervous system systemic embolus, MI, or vascular death with warfarin compared with dual antiplatelet therapy was observed (annual risk 3.93% vs 5.60%, respectively; RR 1.44 [95% CI 1.18 to 1.76]). However, the risk of major hemorrhage was not significantly different between the groups (aspirin plus clopidogrel 2.42% vs warfarin 2.21%; RR 1.10 [95% CI 0.83 to 1.5]). Warfarin demonstrated superiority to dual antiplatelet therapy in clinical outcomes without an increased risk of major bleeding.
Aspirin plus clopidogrel treatment has not been found to be beneficial in patients with recent ischemic stroke or atrial fibrillation.[9,10] In the MATCH trial, a nonsignificant reduction in major vascular events was observed when clopidogrel was added to aspirin (15.7%) versus clopidogrel alone (16.7%), with absolute risk reduction of 1% (95% CI –0.6 to 2.7) in patients with ischemic stroke or transient ischemic attack.[9] Conversely, the risk of major bleeding was increased in the dual antiplatelet group versus clopidogrel alone when administered for a mean of 18 months (2% vs 1%; p <>[10] The study was stopped on the recommendation of the Data Safety and Monitoring Board before the planned follow-up was completed because of the clear evidence of superiority of oral anticoagulation. A significant reduction in the number of a first occurrence of stroke, non–central nervous system systemic embolus, MI, or vascular death with warfarin compared with dual antiplatelet therapy was observed (annual risk 3.93% vs 5.60%, respectively; RR 1.44 [95% CI 1.18 to 1.76]). However, the risk of major hemorrhage was not significantly different between the groups (aspirin plus clopidogrel 2.42% vs warfarin 2.21%; RR 1.10 [95% CI 0.83 to 1.5]). Warfarin demonstrated superiority to dual antiplatelet therapy in clinical outcomes without an increased risk of major bleeding.
# posted by roodbont @ 4:03 AM 
