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 .
Diabetes mellitus, glycoprotein IIb/IIIa blockade, and heparin: evidence for a complex interaction in a multicenter trial. EPILOG Investigators.
BACKGROUND After angioplasty , major complications and ischemic events occur more frequently in diabetic than nondiabetic patients . To determine whether treatment with abciximab is effective in reducing these events in diabetics , we analyzed characteristics and outcomes of diabetic patients enrolled in a large multicenter study ( EPILOG ) . METHODS AND RESULTS Of 2792 patients enrolled , 638 ( 23 % ) were diabetic . Diabetic patients were older , shorter , and heavier ; more likely to be female and have three-vessel disease , prior coronary artery bypass graft surgery , a history of hypertension , or a recent myocardial infa rct ion ; and less likely to be current smokers than their nondiabetic counterparts . During hospitalization , death , myocardial infa rct ion , or urgent revascularization occurred in 7.1 % of diabetics and 7.5 % of nondiabetics . By 6 months , the composite of death and myocardial infa rct ion had occurred in 8.8 % of diabetic patients and 7.4 % of nondiabetics , whereas death , myocardial infa rct ion , or revascularization had occurred in 27.2 % and 22.6 % , respectively . Abciximab treatment reduced death or myocardial infa rct ion among diabetic and nondiabetic patients ( hazard ratios , 0.28 [ 95 % confidence interval ( CI ) , 0.13 to 0.57 ] and 0.47 [ 95 % CI , 0.33 to 0.70 ] at 30 days for diabetics and nondiabetics , respectively , and 0.36 [ 95 % CI , 0.21 to 0.61 ] and 0.60 [ 95 % CI , 0.44 to 0.82 ] at 6 months for diabetics and nondiabetics , respectively ) . Abciximab reduced target vessel revascularization among nondiabetic patients ( hazard ratio , 0.78 [ 95 % CI , 0.63 to 0.96 ] ) but not among diabetics ( hazard ratio , 1.4 [ 95 % CI , 0.94 to 2.08 ] ) . When st and ard- and low-dose heparin adjuncts were compared , diabetics receiving abciximab with st and ard-dose heparin had marginally greater reductions in the composite of death and myocardial infa rct ion and in target vessel revascularization than diabetics assigned to abciximab with low-dose heparin . CONCLUSIONS Abciximab treatment in diabetic patients led to a reduction in the composite of death and myocardial infa rct ion , which was at least as great as that seen in nondiabetic patients . However , target vessel revascularization was reduced in nondiabetic but not diabetic patients . This effect may be associated in part with lower doses of heparin . These differences may be related to differences in the platelet and coagulation systems between diabetics and nondiabetics , the greater extent of coronary artery disease in diabetics , or patient selection and management factors
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 .