Medical+Secondary+Prevention+of+Stroke

__**STATINS**__ //**SPARCL, 2006**//: High-Dose Atorvastatin after Stroke or Transient Ischemic Attack. NEJM 2006; 355:549-559

- control: placebo
====- population: patients who had had a stroke or TIA within 1-6 mo., LDL 100-190 mg/dl, and no known CAD ====

- primary end-point: first nonfatal or fatal stroke
====- outcome: first nonfatal or fatal stroke: treatment 11.2% percent, control 13.1%, 5-year absolute risk reduction 2.2%, relative risk 0.84 CI 0.71-0.99 ====

=__**ANTI-PLATELET THERAPY**__= ====**//PRoFESS, 2008//**: Sacco et al, "Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke." NEJM 2008; 359:1238-51. ====
 * method: double-blind 2-by-2 factorial RCT
 * treatment groups: Aggrenox 25/200 BID or Plavix 75 daily and Telmisartan 80mg daily or placebo
 * N = 20,332
 * population: Age >=50, Ischemic stroke <90 days before randomization as evidenced by symptoms >24h or <24h with evidence of recent infarction on CT or MRI, pts with strokes 90-120 days if >=2 additional vascular risk factors
 * follow-up: mean 2.5 y
 * Primary outcome: first recurrence of any type of stroke
 * Secondary outcome: Composite of stroke, MI, or vascular death
 * Results: No difference in primary or secondary outcomes. More major hemorrhagic events in Aggrenox group (4.1% vs 3.6%, CI 1.00 to 1.32) and more ICH (CI 1.11 to 1.83). No difference in fatal or disabling strokes. More patients discontinued Aggrenox early.
 * Conclusions: Inadequately powered to demonstrate noninferiority but showed similar rates of recurrent stroke in Aggrenox and Plavix groups.

//**ESPRIT, 2006**//: ESPIRIT, Lancet, 2006.

 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">RCT, N=2763
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">Aggrenox vs Aspirin
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">follow-up 3.5y
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">primary outcome: composite of ischemic stroke, MI, vascular death
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">results: primary outcome occurred in 16% in aspirin group and 13% in Aggrenox group

====<span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">**//MATCH, 2004//**: Diener et al, “Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial.” Lancet 2004; 364:331-7. ====
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">RCT, double-blind, ITT
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">N = 7599
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">Treatment: Aspirin 75 mg/d + Plavix 75 mg/d
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">Control: Placebo + Plavix 75 mg/d
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">Follow-up: 18 months
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">Primary outcome: composite of ischemic stroke, MI, vascular death, or rehospitalization for acute ischemia
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%; line-height: 22px;">Results: No significant difference in major vascular events. Life-threatening bleeding 2.6% in ASA+Plavix group, versus 1.3% in Placebo+Plavix group. No difference in mortality found.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">//**CAPRIE, 1996**//: CAPRIE, Lancet, 1996.

 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">RCT, N=19,185
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">Plavix vs Aspirin
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">Follow-up 1.91 years
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">Primary outcome: composite of ischemic stroke, MI, vascular death
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 90%;">Results: primary outcome occurred in 5.83% per year in aspirin group and 5.32% in Plavix group, P=0.043, RR reduction of 8.7%

**//ESPS, 1996:// Diener et al, Journal of the Neurologial Scienes, 1996. **

 * RCT, 2x2 factorial design, N=6,602
 * ASA 25 BID vs Dipyridamole 200 BID vs Aggrenox 25-200 BID vs Placebo
 * Primary outcomes: stroke, death, and stroke and/or death
 * With regards to risk of stroke and risk of stroke and/or death, Aggrenox outperformed ASA alone and Dipyridamole alone, both of which outperformed placebo. There was no difference in overall death.