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 .
Long-term treatment with a platelet glycoprotein-receptor antagonist after percutaneous coronary revascularization. EXCITE Trial Investigators. Evaluation of Oral Xemilofiban in Controlling Thrombotic Events.
BACKGROUND When administered intravenously at the time of percutaneous coronary revascularization , glycoprotein IIb/IIIa receptor antagonists decrease the incidence of death and nonfatal myocardial infa rct ion and the need for urgent revascularization . We hypothesized that long-term administration of oral glycoprotein IIb/IIIa antagonists , which block the aggregation of platelets , might stabilize intravascular plaque and prevent additional ischemic cardiac events . METHODS We conducted a prospect i ve , double-blind trial in which 7232 patients were r and omly assigned to receive 20 mg of oral xemilofiban or placebo 30 to 90 minutes before undergoing percutaneous coronary revascularization , with maintenance doses of 10 or 20 mg of xemilofiban or placebo administered three times daily for up to 182 days . There were two primary composite end points : one was death , nonfatal myocardial infa rct ion , or urgent revascularization at 182 days , and the other was death or nonfatal myocardial infa rct ion at 182 days . RESULTS Death , myocardial infa rct ion , or urgent revascularization occurred within 182 days in 324 patients who received  placebo  ( Kaplan-Meier cumulative event rate , 13.5 percent ) , 332 who received 10 mg of xemilofiban ( 13.9 percent , P=0.82 for the comparison with placebo ) , and 306 who received 20 mg of xemilofiban ( 12.7 percent , P=0.36 for the comparison with placebo ) . The incidence of death or myocardial infa rct ion was also similar in all three groups . Clinical ly significant hemorrhagic complications and thrombocytopenia were infrequent . CONCLUSIONS The administration of the glycoprotein IIb/IIIa antagonist xemilofiban before percutaneous coronary revascularization and for up to six months thereafter does not significantly reduce the incidence of important clinical end points
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 .