Acetylsalicylic acid ( ASA ) did not reduce stroke or ' all cardiovascular events ' compared to placebo in primary prevention patients with elevated blood pressure and no prior cardiovascular disease .
Antiplatelet therapy with ASA for primary prevention in patients with elevated blood pressure provides a benefit , reduction in myocardial infa rct ion , which is negated by a harm of similar magnitude , increase in major haemorrhage .
The benefit of antiplatelet therapy for secondary prevention in patients with elevated blood pressure is many times greater than the harm .
Benefit has not been demonstrated for warfarin therapy alone or in combination with aspirin in patients with elevated blood pressure .
BACKGROUND Elevated systemic blood pressure results in high intravascular pressure but the main complications , coronary heart disease ( CHD ) , ischaemic strokes and peripheral vascular disease ( PVD ) , are related to thrombosis rather than haemorrhage .
Some complications related to elevated blood pressure , heart failure or atrial fibrillation , are themselves associated with stroke and thromboembolism .
Therefore it is important to investigate if antithrombotic therapy may be useful in preventing thrombosis-related complications in patients with elevated blood pressure .
OBJECTIVES To conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with high blood pressure , including those with elevations in both systolic and diastolic blood pressure , isolated elevations of either systolic or diastolic blood pressure , to address the following hypotheses : ( i ) antiplatelet agents reduce total deaths and /or major thrombotic events when compared to placebo or other active treatment ; and ( ii ) oral anticoagulants reduce total deaths and /or major thromboembolic events when compared to placebo or other active treatment .
Ticlopidine , clopidogrel and newer antiplatelet agents such as prasugrel and ticagrelor have not been sufficiently evaluated in patients with high blood pressure .
The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group.
BACKGROUND Many trials in patients with acute myocardial infa rct ion have demonstrated that thrombolytic therapy is not associated with an excessive risk of stroke , as compared with conventional treatment . However , the incidence of various forms of stroke in patients treated with different thrombolytic and antithrombotic regimens  and the associated effect of risk factors for stroke are largely unknown . METHODS Strokes occurring in patients hospitalized with acute myocardial infa rct ion who were enrolled in either of two large trials were analyzed . The patients were r and omly assigned to receive streptokinase ( 1.5 million units ) or recombinant tissue plasminogen activator ( t-PA ) ( 100 mg ) and also r and omly assigned to receive subcutaneous heparin or no heparin . Ninety-one percent of the patients also received aspirin . RESULTS Complete data were available on 20,768 patients . A total of 236 ( 1.14 percent ) had strokes in the hospital ; 0.36 percent had hemorrhagic strokes , 0.48 percent ischemic strokes , and 0.30 percent strokes of undefined cause . Patients treated with t-PA had a small but significant excess of stroke as compared with those who received streptokinase ( 1.33 vs. 0.94 percent ; adjusted odds ratio , 1.42 ; 95 percent confidence interval , 1.09 to 1.84 ) . The administration of subcutaneous heparin in addition to a thrombolytic agent did not increase the risk of stroke ( risk with heparin , 1.13 percent ; without heparin , 1.14 percent ) . Older age , a higher Killip class , and the occurrence of anterior infa rct ion significantly increased the risk of stroke , whereas a higher body-mass index or a history of hypertension , diabetes , or smoking did not . CONCLUSIONS Patients with acute myocardial infa rct ion who receive thrombolytic therapy have a small risk of stroke . Treatment with t-PA as compared with streptokinase result ed in a small but significant excess of stroke . Subcutaneous heparin , given together with t-PA or streptokinase and aspirin , did not result in an increased risk of stroke
Acetylsalicylic acid ( ASA ) did not reduce stroke or ' all cardiovascular events ' compared to placebo in primary prevention patients with elevated blood pressure and no prior cardiovascular disease .
Antiplatelet therapy with ASA for primary prevention in patients with elevated blood pressure provides a benefit , reduction in myocardial infa rct ion , which is negated by a harm of similar magnitude , increase in major haemorrhage .
The benefit of antiplatelet therapy for secondary prevention in patients with elevated blood pressure is many times greater than the harm .
Benefit has not been demonstrated for warfarin therapy alone or in combination with aspirin in patients with elevated blood pressure .
BACKGROUND Elevated systemic blood pressure results in high intravascular pressure but the main complications , coronary heart disease ( CHD ) , ischaemic strokes and peripheral vascular disease ( PVD ) , are related to thrombosis rather than haemorrhage .
Some complications related to elevated blood pressure , heart failure or atrial fibrillation , are themselves associated with stroke and thromboembolism .
Therefore it is important to investigate if antithrombotic therapy may be useful in preventing thrombosis-related complications in patients with elevated blood pressure .
OBJECTIVES To conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with high blood pressure , including those with elevations in both systolic and diastolic blood pressure , isolated elevations of either systolic or diastolic blood pressure , to address the following hypotheses : ( i ) antiplatelet agents reduce total deaths and /or major thrombotic events when compared to placebo or other active treatment ; and ( ii ) oral anticoagulants reduce total deaths and /or major thromboembolic events when compared to placebo or other active treatment .
Ticlopidine , clopidogrel and newer antiplatelet agents such as prasugrel and ticagrelor have not been sufficiently evaluated in patients with high blood pressure .