Acetylsalicylic acid ( ASA ) did not reduce stroke or ‘ all cardiovascular events ’ compared to placebo in primary prevention patients with elevated BP and no prior cardiovascular disease .
To conclude for primary prevention in patients with elevated BP , antiplatelet therapy with ASA can not be recommended since the magnitude of benefit , a reduction in myocardial infa rct ion , is negated by a harm of similar magnitude , an increase in major haemorrhage .
Although elevated systemic blood pressure ( BP ) results in high intravascular pressure , the main complications of hypertension are related to thrombosis rather than haemorrhage .
It therefore seemed plausible that use of antithrombotic therapy may be useful in preventing thrombosis-related complications of elevated BP .
The objectives were to conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with BP , 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 .
Stroke in patients with acute coronary syndromes: incidence and outcomes in the platelet glycoprotein IIb/IIIa in unstable angina. Receptor suppression using integrilin therapy (PURSUIT) trial. The PURSUIT Investigators.
BACKGROUND The incidence of stroke in patients with acute coronary syndromes has not been clearly defined because few trials in this patient population have been large enough to provide stable estimates of stroke rates . METHODS AND RESULTS We studied the 10 948 patients with acute coronary syndromes without persistent ST-segment elevation who were r and omly assigned to placebo or the platelet glycoprotein IIb/IIIa receptor inhibitor eptifibatide in the Platelet Glycoprotein IIb/IIIa in Unstable Angina : Receptor Suppression Using Integrilin Therapy ( PURSUIT ) trial to determine stroke rates , stroke types , clinical outcomes in patients with stroke , and independent baseline clinical predictors for nonhemorrhagic stroke . Stroke occurred in 79 ( 0.7 % ) patients , with 66 ( 0.6 % ) nonhemorrhagic , 6 intracranial hemorrhages , 3 cerebral infa rct ions with hemorrhagic conversion , and 4 of uncertain cause . There were no differences in stroke rates between patients who received placebo and those assigned high-dose eptifibatide ( odds ratios and 95 % confidence intervals 0.82 [ 0.59 , 1.14 ] and 0.70 [ 0.49 , 0.99 ] , respectively ) . Of the 79 patients with stroke , 17 ( 22 % ) died within 30 days , and another 26 ( 32 % ) were disabled by hospital discharge or 30 days , whichever came first . Higher heart rate was the most important baseline clinical predictor of nonhemorrhagic stroke , followed by older age , prior anterior myocardial infa rct ion , prior stroke or transient ischemic attack , and diabetes mellitus . These factors were used to develop a simple scoring nomogram that can predict the risk of nonhemorrhagic stroke . CONCLUSIONS Stroke was an uncommon event in patients with acute coronary syndromes in the PURSUIT trial . These strokes are , however , associated with substantial morbidity and mortality rates . The majority of strokes were of nonhemorrhagic causes . Eptifibatide was not associated with an increase in intracranial hemorrhage , and no significant effect on nonhemorrhagic stroke was observed . We developed a useful nomogram for assigning baseline nonhemorrhagic stroke risk in this patient population
Acetylsalicylic acid ( ASA ) did not reduce stroke or ‘ all cardiovascular events ’ compared to placebo in primary prevention patients with elevated BP and no prior cardiovascular disease .
To conclude for primary prevention in patients with elevated BP , antiplatelet therapy with ASA can not be recommended since the magnitude of benefit , a reduction in myocardial infa rct ion , is negated by a harm of similar magnitude , an increase in major haemorrhage .
Although elevated systemic blood pressure ( BP ) results in high intravascular pressure , the main complications of hypertension are related to thrombosis rather than haemorrhage .
It therefore seemed plausible that use of antithrombotic therapy may be useful in preventing thrombosis-related complications of elevated BP .
The objectives were to conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with BP , 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 .