Acute Ischemic Stroke Drugs

7/31/2019 Acute Ischemic Stroke Drugs

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Acute Ischemic

Stroke Drugs


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Platelet Function Under Aspirin, Clopidogrel,

and Both After Ischemic Stroke

CD63 expression reflecting the release of platelet lysosomes is consistentlyincreased after stroke and incompletely suppressed by treatment with aspirin,

clopidogrel, or both. The strong prolongation of CADP-CT under combined

aspirin and clopidogrel in a patient subgroup may indicate a lower risk of

thrombosis but also a higher risk of hemorrhage

Combined antiplatelet agents may offer additive protection over single drugs

after stroke. We investigated whether platelet activation is reduced under

combined aspirin and clopidogrel compared with each drug alone


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A New Approach to Antithrombotic Therapy Evaluation of

Combined Therapy of Thromboxane Synthetase Inhibitor and

Very Low Dose of Aspirin

A very low dose of aspirin enhances the ability of OKY-046 toinhibit platelet aggregation and this combination therapy (OKY-

046 100 mg and a very low dose of aspirin which inhibits platelet

cyclooxygenase activity approximately 50%) may be of value as a

new approach to antithrombotic therapy

The effect of a selective thromboxane (TX) synthetase inhibitor (OKY-046),

alone and in combination with a very low dose of aspirin, on the platelet

function was studied in healthy and diseased subjects


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A Randomized Trial of Aspirin or Heparin In

Hospitalized Patients With Recent Transient

Ischemic Attacks

No significant difference between aspirinand heparin treatment in preventing

recurrent TIAs or cerebral infarction

compared the efficacy of temporary anticoagulation with intravenous heparin sodium

to the efficacy of aspirin in preventing cerebral infarction in

hospitalized patients with recent (


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Antiplatelet Effect of Aspirin in Patients

With Cerebrovascular Disease

There is a significant percentage of patients taking ASA

have no detectable antiplatelet effect using the PFA-100

test. This lack of effect was most common in patients

taking low-dose ASA or an enteric-coated ASA

preparation

Aspirin is used commonly to prevent ischemic strokes and other vascular events.

Although aspirin is considered safe and effective, it has limited efficacy with a relative

risk reduction of 20% to 25% for ischemic stroke. We sought to determine if aspirin as

currently used is having its desired antiplatelet effects


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Antiplatelet Therapy in Acute

Cerebral Ischemia

Antiplatelet drugs represent a diverse group of agents that share the ability toreduce platelet activity through a variety of mechanisms. Antiplatelet agents

such as aspirin may affect both NO and prostacyclin levels, their biological

activities go well beyond the platelet and include effects both locally on other

blood elements and within the vessel wall

Antiplatelet agents are a heterogenous class of drugs that have been successfully used

for more than2 decades in secondary stroke prevention. These agents include aspirin,

with or without dipyridamole, and more recently, the adenosine antagoniststiclopidine and clopidogrel


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Aspirin Effective in Males

Threatened with Stroke

The results indicate a clear and statistically significant risk reduction (19%, P < 0.05)

from aspirin. A second analysis, omitting the TIA endpoint, indicated a 31% risk

reduction in stroke or death from aspirin (P < 0.05). Sulfinpyrazone did not produce a

statistically significant risk reduction for either group of events, nor was there

significant synergism with, nor antagonism to, aspirin therapy.A 48% risk reduction {P

< 0.005) in stroke or death was found for male patients on aspirin but females did not

appear to benefit.

A CLINICAL TRIAL on 2 drugs which inhibit platelet function has been concluded after 5'/2 years

of cooperative effort. The results indicate that male patients threatened with stroke will benefit

by the daily use of the commonest and one of the oldest pharmaceutical agents aspirin.Females will not benefit and neither men nor women will benefit from the use of sulfinpyrazone


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Aspirin Inhibits p44/42 Mitogen-Activated Protein

Kinase and Is Protective Against

Hypoxia/Reoxygenation Neuronal Damage

ASA is neuroprotective against H/R damage partially by inhibitingthe ERK signaling pathway. When one considers previous reports

on the neuroprotective mechanisms of ASA, the combination of

multiple pharmacological activities and sites of action may explain

the beneficial effects of ASA on patients with high stroke risk

Acetylsalicylic acid (ASA) is preventive against stroke and protects against focal brain

ischemia in rats. We studied the mechanisms of the manner in which ASA provides

neuroprotection against hypoxia/reoxygenation (H/R) injury


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Aspirin Plus Dipyridamole Versus Aspirin for

Prevention of Vascular Events After Stroke or TIA

The combination of aspirin plus dipyridamole is more effective than aspirinalone in preventing stroke and other serious vascular events in patients with

minor stroke and TIAs. The risk reduction was greater and statistically

significant for studies using primarily extended release dipyridamole, which

may reflect a true pharmacological effect or lack of statistical power in studies

using immediate release dipyridamole

This meta-analysis systematically reviewed randomized controlled trials comparing

aspirin plus dipyridamole with aspirin alone in patients with stroke and TIA to

determine the efficacy of these agents in preventing recurrent cerebral and systemicvascular events


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Aspirin Response and Failure in

Cerebral Infarction

How the inhibition of platelet aggregation relates to stroke prevention remains unclear.The ability of aspirin and the dose required to inhibit platelet aggregation may depend

upon the individual. The results of the present study suggest that noncompliance is

rare and that certain individuals develop a biological effect of ASA (inhibition of

platelet aggregation) at a different but greater ASA dose and that others may never

respond in this manner to ASA

The purpose of this study was to assess the biological effect of aspirin as

measured by the inhibition of platelet aggregation in patients taking aspirin

for stroke prevention and in patients with acute stroke


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Aspirin Use and Incident Stroke in

the Cardiovascular Health Study

These analyses of the CHS cohort in which aspirin use was largely self-determinedsuggest that the regular use of aspirin may be associated with increased risk of stroke,

both ischemic and hemorrhagic, in older women. Among men, those with recognized

cardiovascular disease who used aspirin had lower rates of stroke than nonusers of

aspirin, while those who were aspirin users without cardiovascular disease had slightly

higher rates, but none of these findings were statistically significant

Randomized clinical trials testing aspirin in relatively low-risk, middle-aged people have

consistently shown small increases in stroke associated with aspirin use. We analyzed the

relationship between the regular use of aspirin and incident ischemic and hemorrhagic strokeamong people aged 65 years or older participating in the Cardiovascular Health Study


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Aspirin Versus Low-Dose Low-Molecular-Weight

Heparin: Antithrombotic Therapy in Pediatric

Ischemic Stroke Patients

This multicenter follow-up study provides evidence that drug-

related side effects were rare in both treatment arms and that

low-dose LMWH is not superior to medium dose aspirin or vice

versa as recurrent stroke prophylaxis in white pediatric patients

We sought to compare different antithrombotic secondary treatments (mainly

medium-dose aspirin with low-dose low-molecular-weight heparin [LMWH]) in

pediatric patients with a first ischemic stroke onset with regard to the risk of strokerecurrence


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Benefit of Clopidogrel Over Aspirin Is

Amplified in Patients With a History of

Ischemic Events

Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events(CAPRIE) patients with a history of prior symptomatic

atherosclerotic disease had a high rate of subsequent ischemic

events. The absolute benefit of clopidogrel over ASA seemed to

be amplified in such high-risk patients

The goal of this study was to examine the influence of preexisting symptomatic

atherosclerotic disease on subsequent ischemic event rates and compare the efficacy

of clopidogrel versus aspirin (acetylsalicylic acid, ASA) in patients with such disease


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Biological Assessment of Aspirin Efficacy

on Healthy Individuals

Our findings suggest that full resistance of healthy subjects to aspirin is ratherunlikely. However, differences in aspirin absorption, or pharmacokinetic, or

other unrecognized factors may lead to lack of effect of low dose of aspirin in

some subjects when using tests like platelet function analyzer-100. Whether

Cox polymorphisms are thrombotic risk factor for patients under aspirin will

require further research

The widespread use of aspirin requires clarification of the aspirin resistance

phenomenon. Most studies on this field are focused on patients which may

affect the action of aspirin


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Cerebral Hemorrhagic Risk of Aspirin or

Heparin Therapy With Thrombolytic

Treatment in Rabbits

Aspirin antiplatelet therapy alone may increasethe risk of hemorrhagic infarction, whereas

heparin or tissue plasminogen activator therapy

appears to be relatively safe

We studied the incidence of cerebral hemorrhage in an animal model of

embolic stroke to determine the safety of aspirin, heparin, and tissue

plasminogen activator therapies


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Combination Therapy With Low-Dose Aspirin

and Ticlopidine in Cerebral Ischemia

Platelet survival was prolonged and platelet lysis was reduced after treatment with

aspirin plus ticlopidine despite the fact that neither measure of platelet function was

significantly altered after treatment with aspirin alone or ticlopidine alone.

On the other hand, hemorrhagic complications were observed more frequently among

patients treated with aspirin plus ticlopidine than among those treated with aspirin

alone or ticlopidine alone. Our results indicate that the combination of aspirin plus

ticlopidine is a potent antiplatelet strategy

We compared combination therapy with low-dose aspirin plus ticlopidine to

therapy with aspirin alone or ticlopidine alone in patients suffering transient

ischemic attack or cerebral infarction


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Combining Aspirin With Oral Anticoagulant Therapy

Is This a Safe and Effective Practice in Patients With

Atrial Fibrillation?

The combination therapy of aspirin with either ximelagatran or warfarin did not reduce

the risk of stroke, systemic embolism, or myocardial infarction, but the addition of

aspirin to warfarin or ximelagatran was associated with increased risk of bleeding,

which was especially obvious when aspirin and warfarin were combined. Similar to the

combination of aspirin plus clopidogrel, the combination of an antiplatelet agent and

an oral anticoagulant in stroke patients seems to increase the risk of intracranial

hemorrhage

The Stroke Prevention Using an ORal Thrombin Inhibitor in atrial Fibrillation

(SPORTIF) investigators studied the risks and benefits of combining aspirinwith oral anticoagulant therapy in patients with AF


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Comparison of Triflusal and Aspirin for

Prevention of Vascular Events in Patients After

Cerebral Infarction

This study failed to show significantly superior efficacy of triflusalover aspirin in the long-term prevention of vascular events after

stroke, but triflusal was associated with a significantly lower rate

of hemorrhagic complications

The efficacy of the antiplatelet agent triflusal for prevention of vascular

events after stroke has been reported in a pilot study. However, there is a

need to confirm those results in a larger study


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Differences in Medical and Surgical Therapy for

Stroke Prevention Between Leading Experts in

North America and Western Europe

This analysis shows significant differences in several areas of strokeprevention practices between leading experts from NA and WE. Aspirin was

the first-choice antiplatelet agent in patients with a recent TIA or minor stroke

in both groups, recommended doses varied significantly. aspirin doses of 500

mg daily are given exclusively by American participants (36%), whereas doses

,200 mg are recommended only in Europe (51%)

The purpose of this analysis was to provide an informative and comparative view of

the current practice of leading experts in North America (NA) and Western Europe

(WE), where most of the large prevention trials have been performed


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Effect of Aspirin and Warfarin Therapy in

Stroke Patients With Valvular Strands

While on medical therapy, valvular strands do not significantlyincrease recurrent adverse event rates in patients with ischemic

stroke. Furthermore, the study does not provide evidence to

support an advantage of warfarin or aspirin for this purpose

Valvular strands are associated with ischemic stroke. The recurrent rate of adverse

events in stroke patients with valvular strands has not been defined and, importantly,

there are no randomized studies to evaluate efficacy of antithrombotic therapies inthese patients


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Effects of Clopidogrel and Aspirin in Combination Versus

Aspirin Alone on Platelet Activation and Major Receptor

Expression in Patients After Recent Ischemic Stroke

Treatment with clopidogrel with aspirin (C+ASA) for 1 monthprovides significantly greater inhibition of platelet activity than

ASA alone in patients after recent ischemic stroke in the frame of

the small randomized trial

To determine whether clopidogrel with aspirin (C+ASA) will produce more potent

platelet inhibition than aspirin alone (ASA) in patients after ischemic stroke, we

conducted the Plavix Use for Treatment of Stroke trial


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Effects of Fixed Low-Dose Warfarin, Aspirin-Warfarin

Combination Therapy, and Dose-Adjusted Warfarin

on Thrombogenesis in Chronic Atrial Fibrillation

Moreover, the introduction of 300 mg aspirin plus low-dose warfarin (1 mg/d),

low-dose warfarin alone (2 mg/d), or 300 mg aspirin plus low-dose warfarin (2

mg/d) did not significantly reduce any of the hemostatic markers studied

(except PAI-1 levels), whereas conventional full-dose warfarin (INR 2.0 to 3.0)

significantly reduced levels of fibrin D-dimer and fibrinogen

To determine whether introduction of fixed low-dose warfarin alone or in combination with

aspirin (300 mg) could normalize hemostatic markers, namely plasma fibrin D-dimer (an index of

thrombogenesis), plasminogen activator inhibitor-1 (PAI-1, an index of fibrinolysis), fibrinogen,

and von Willebrand factor (vWf, an index of endothelial dysfunction), in a manner comparableto adjusted-dose warfarin (target INR 2.0 to 3.0)


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Effects of Low-to-High Doses of Aspirin on

Platelet Aggregability and Metabolites of

Thromboxane A2 and Prostacyclin

Different doses of aspirin may be necessary to prevent thrombogenesisinduced by different triggers of different strengths and that 40 mg/day aspirin

is able to inhibit a large proportion of maximum thromboxane A2 release

provoked acutely, with the prostaglandin I2 synthesis being little affected;

however, higher doses of aspirin are required to attain further inhibition

The purpose of this study was to compare the effects of low-to-high doses of

aspirin on platelet aggregability determined by different methods and on the

metabolism of thromboxane A2 and prostacyclin


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Efficacy of Ticlopidine and Aspirin for Prevention of

Reversible Cerebrovascular Ischemic Events

The results in this subgroup of patients with reversible

ischemic disease, as well as the overall analysis of TASS,

suggest that ticlopidine is a more effective agent than

aspirin for the prevention of recurrent transient

ischemic attacks

This subgroup analysis from the Ticlopidine Aspirin Stroke Study (TASS) compared ticlopidine, a

new antiplatelet agent, with aspirin for the prevention of recurrent transient ischemic attacks in

patients who had a recent reversible cerebrovascular event


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Endothelial Cell Ischemic Injury: Protective Effect of

Heparin or Aspirin Assessed by

Scanning Electron Microscopy

This investigation illustrates an endothelial abnormality whichappears to be influenced by two pharmacological agents

considered possibly beneficial in preventing thromboembolic

phenomena related to heart attacks and strokes in man

The present study was undertaken to examine the effects of heparin and

aspirin in doses having significant antiplatelet aggregating activity


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Factors Associated With Ischemic Stroke

During Aspirin Therapy in Atrial Fibrillation

Postmenopausal estrogen replacement therapy

and moderate alcohol consumption may

additionally modify the risk of stroke in AF

Nonvalvular atrial fibrillation (AF) is a strong, independent risk factor for stroke, but the

absolute rate of stroke varies widely among AF patients, importantly influencing the potential

benefit of antithrombotic prophylaxis. We explore factors associated with ischemic stroke in AF

patients taking aspirin


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Increased Platelet Sensitivity to Collagen in

Individuals Resistant to Low-Dose Aspirin

ASA resistance may be caused by an increased sensitivity ofplatelets to collagen. A platelet aggregation study specific for

collagen dose response may be useful for strict selection of ASA

responders for low-dose ASA therapy and for identifying ASA

nonresponders for high-dose ASA therapy

The purpose of this study was to assess individual differences in the pharmacological

effects of acetylsalicylic acid (ASA) on bleeding time as measured by in vitro platelet

aggregation and to examine the consistency of responses over time


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Indications for Early Aspirin Use

in Acute Ischemic Stroke

Early aspirin is of benefit for a wide range of patients, and its prompt useshould be routinely considered for all patients with suspected acute ischemic

stroke, mainly to reduce the risk of early recurrence. No strong

contraindications are apparent and that hemorrhagic stroke can be excluded

with reasonable probability (with or without prior CT scan)

Starting daily aspirin promptly in patients with suspected acute ischemic stroke also reduces the

immediate risk of further stroke or death in hospital and the overall risk of death or dependency.

However, some uncertainty remains about the effects of early aspirin in particular categories of

patient with acute stroke


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Low-Dose Aspirin for Prevention of Stroke in

Low-Risk Patients With Atrial Fibrillation

For prevention of stroke in patients with NVAF,

aspirin at 150 to 200 mg per day does not seem

to be eithereffective or safe

We examined the efficacy and safety of aspirin therapy in

Japanese patients with nonvalvular atrial fibrillation (NVAF) in a

prospective randomized multicenter trial


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Nonaspirin Nonsteroidal Anti-inflammatory

Drugs and Hemorrhagic Stroke Risk

No increased risk of HS either subarachnoid

hemorrhage or intracerebral hemorrhage was

found among NANSAIDs users

The relationship between nonaspirin nonsteroidal anti-inflammatory drugs

(NANSAIDs) and hemorrhagic stroke (HS) remains unclear. We examined the risk of HS

associated with the use of NANSAIDs in Koreans


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Platelet Aggregation in Patients With Atrial

Fibrillation Taking Aspirin or Warfarin

Aspirin at the dosage used in the SPAF study (325 mg/d) did not completelyinhibit platelet aggregation in all patients. the presence of hyperaggregable

platelets in warfarin-treated patients and lack of complete inhibition of

platelet aggregation in aspirin-treated patients may be related to medication

failure in these patients.

The purpose of this study was to determine inhibition of platelet aggregation

in patients on aspirin and platelet reactivity in those on warfarin in the

Stroke Prevention in Atrial Fibrillation study


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Previous Use of Aspirin and

Baseline Stroke Severity

No evidence that previous aspirin use hasany effect on the type and severity of

ischemic stroke at baseline or on the

outcome at 6 months

Some studies suggest that taking aspirin regularly at the time of the onset of stroke reduces

stroke severity. Other studies suggest the converse (ie, that previous aspirin therapy is

associated with greater stroke severity). We sought to examine this question among the patients

enrolled in the International Stroke Trial (IST)


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Prospective Study of Aspirin Use and

Risk of Stroke in Women

These prospective data indicate that women who take 1 to 6 aspirin per week have a

reduced risk of large-artery occlusive infarction, but those who use 15 or more aspirinper week have an increased risk of subarachnoid hemorrhage. This observational study

suggests benefits of aspirin for ischemic stroke with low frequency of use and hazards

for hemorrhagic stroke with high frequency of use, particularly among older or

hypertensive women. Thus, the effect on total stroke will depend on the dose of aspirin

and the distribution of stroke subtypes and risk factors in the population

In secondary prevention, aspirin reduces risk of ischemic stroke. In primary

prevention of stroke, however, the role of aspirin is uncertain, especially in

women


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Regular Aspirin-Use Preceding the Onset of Primary

Intracerebral Hemorrhage is an Independent

Predictor for Death

We observed poor short-term outcomes and increased mortality,probably attributable to rapid enlargement of hematomas, in the

subjects with ICH who had been taking regularly moderate doses

of aspirin (median 250 mg) immediately before the onset of the

stroke

The effect of preceding aspirin-use on outcome after ICH is poorly

investigated. We investigated short-term mortality and hematoma

enlargement in subjects with ICH to find the predictors for these outcomes


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Risk of Hemorrhagic Stroke With

Aspirin Use

Based on the rarity of hemorrhagic stroke risk, concerns aboutthis risk should not dissuade appropriate patients from using

low-dose aspirin. Choosing doses between 75 mg and 325 mg per

day provides an optimal benefit to risk relationship

This review provides an update of the available data to offer greater clarity

regarding the risks of aspirin with respect to hemorrhagic stroke, as well as

insights regarding patient selection to minimize the risk of this complication


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Risk of Intracerebral Hemorrhage in Patients With

Arterial Versus Cardiac Origin of Cerebral Ischemia

on Aspirin or Placebo

Our findings do not confirm the previous finding of an excess riskof ICH in patients with cerebral ischemia of arterial origin.

Therefore, it seems that having cerebral ischemia of arterial

origin by itself is not associated with an increased risk of ICH, but

only in combination with high-intensity anticoagulation

To determine whether this excess risk of ICH was due to the underlying disease

(cerebral ischemia of arterial versus cardiac origin) or whether it depended on the

antithrombotic regimen, we studied the risk of ICH in arterial versus cardiac origin ofcerebral ischemia in patients who received aspirin or no antithrombotic drugs


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Risks and Benefits of Oral Anticoagulation Compared

With Clopidogrel Plus Aspirin in Patients With Atrial

Fibrillation According to Stroke Risk

In this clinical trial, patients with a CHADS21 had a low risk ofstroke, yet still derived a modest (1% per year) but statistically

significant absolute reduction in stroke with OAC and had low

rates of major hemorrhage on OAC

Oral anticoagulation (OAC) was more efficacious than combined clopidogrel plus aspirin (CA) in

preventing vascular events in patients with atrial fibrillation. However, because OAC carries

important bleeding complications, risk stratification schemes have been devised to identify

patients for whom the absolute benefits of OAC exceed its risks


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Screening for Aspirin Responsiveness After

Transient Ischemic Attack and Stroke

The prevalence of apparent ASA nonresponsiveness was higher with both the

POC tests than with LTA. However, agreement between the tests was poor and

very few patients were ASA nonresponsive by all 3 tests. Aspirin

nonresponsiveness is therefore highly test-specific and large prospective

studies will be required to determine the prognostic value of each of the

separate tests

The availability of simple to use point-of-care (POC) platelet function testsnow potentially allows

aspirin nonresponsiveness to be identified in routine clinical practice. However, there are

veryfew data on whether the different tests produce consistent results. We therefore compared

2 POC tests (PFA-100 device and the Ultegra-RPFA [RPFA]) with conventional light transmissionaggregometry (LTA)


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Therapeutic Benefit Aspirin Revisited in Light

of the Introduction of Clopidogrel

Aspirin is preferred for the majority of stroke or myocardial infarction patients

at risk of recurrent atherothrombotic events. Clopidogrel may, however,

provide valuable therapeutic benefit over aspirin in patients with peripheral

arterial disease and in stroke or myocardial infarction patients for whom

aspirin treatment is contraindicated or for whom aspirin fails to achieve the

desired therapeutic effect

Whether to switch from the well-established practice of recommending aspirin for use

in patients with atherothrombotic disease, both aspirin and clopidogrel are compared

with respect to the primary factors that influence such decisions

Thi idi A i i P S k


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Thienopyridines or Aspirin to Prevent Stroke

and Other Serious Vascular Events in Patients

at High Risk of Vascular Disease?

The thienopyridines appear modestly more effective than aspirin

in preventing serious vascular events in high-risk patients.Clopidogrel appears to be safer than ticlopidine and as safe as

aspirin, making it an appropriate, but more expensive,

alternative antiplatelet drug for patients unable to tolerate

aspirin

Aspirin is the most widely studied and prescribed antiplatelet drug for patients at high

risk of vascular disease. We aimed to establish how the thienopyridines (ticlopidine

and clopidogrel) compare with aspirin in terms of effectiveness and safety


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Ticlopidine Versus Aspirin for the

Prevention of Recurrent Stroke

Ticlopidine is somewhat more effective thanaspirin for reducing the risk of stroke in patients

with a completed minor stroke

We therefore performed an analysis on a subgroup of patients

from the Ticlopidine Aspirin Stroke Study (TASS) with a recent

minor completed stroke as the qualifying ischemic event


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Use of Aspirin, Epistaxis, and Untreated Hypertension as Risk

Factors for Primary Intracerebral Hemorrhage in Middle-Aged

and Elderly People

Epistaxis is a risk factor for ICH in middle-aged and elderly

people, both independently and combined with the use ofaspirin. Other independent risk factors are untreated

hypertension, previous ischemic stroke, epilepsy, and recent

strenuous physical exertion. Epistaxis may be a warning sign of

an increased risk for ICH in subjects using aspirin

The incidence of primary intracerebral hemorrhage (ICH) increases exponentially with

age, but the risk factors are not well known. We investigated lifestyle factors, previous

diseases, and medications as risk factors for ICH in middle-aged and elderly people


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Clopidogrel-Associated TTP

Clopidogrel-associated TTP often occurs within 2 weeks

of drug initiation, occasionally relapses, and has a high

mortality if not treated promptly

This study assessed the completeness of information on TTP diagnosis,

treatment response, and causality from the 3 reporting systems. In addition,

predictors of mortality were identified through classification tree analysis.


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The Risks and Safety of Clopidogrel in

Pediatric Arterial Ischemic Stroke

Clopidogrel to be relatively well tolerated in thepediatric population. In combination with aspirin

and in the presence of other risk factors,

intracranial bleeding may be seen

The purpose of this study was to determine safety and tolerability of clopidogrel in

children with arterial ischemic stroke (AIS). Clopidogrel is the alternative antiplatelet

medication when aspirin is not tolerated or fails


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Acute Ischemic Stroke Drugs

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