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(Stroke. 2006;37:2428.)
© 2006 American Heart Association, Inc.

Emerging Therapies

CHARISMA

The Antiplatelet Saga Continues

Marc Fisher, MD; Kennedy Lees, MD, Section Editors:; John W. Norris, MD Henry J. Barnett, MD, CC

From the St Georges Medical School (J.W.N.), University of London, UK; and the Robarts Research Institute (H.J.B.), London, Ontario, Canada.

Correspondence to John W. Norris, MD, FRCP, Centre for Clinical Neuroscience, St Georges Medical School, University of London, London SW17 0RE, UK. E-mail carotid@btopenworld.com

Key Words: antiplatelet agents • antiplatelet drugs • clinical trials

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Ever since the Antithrombotic Trialists reported a clear benefit from aspirin in the secondary prevention of vascular disease in patients with a variety of cardiovascular events,¹ there has been a search for more effective antithrombotic agents. The first relatively nontoxic drug to undergo randomized clinical trial was clopidogrel in the CAPRIE study² (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) where 3 groups of patients (myocardial ischemia (MI), ischemic stroke or peripheral arterial disease) were given either aspirin or the drug. The compound end point of MI, ischemic stroke and vascular death was significantly reduced by clopidogrel compared with patients taking aspirin. However, the substantial benefit on vascular outcome evident in the peripheral vascular group was not shared by either the stroke patients or those with MI.

Because aspirin and clopidogrel have different biochemical pathways inhibiting platelet adhesiveness, a combination of the 2 drugs might be even more effective in secondary prevention of vascular events. In CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events) the dual antiplatelet therapy was found even more beneficial than clopidogrel alone in reducing combined cardiac and cerebral ischemic end points, but a group with aspirin alone was not included.³ This was followed by CREDO (Clopidogrel for the Reduction of Events During Observation), and once again clopidogrel was found more effective than placebo in reducing the compound end points of death and myocardial and cerebral infarction in patients undergoing percutaneous coronary intervention.⁴

However, all these studies failed to show any significant prophylactic effect . . . [Full Text of this Article]

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