Drug therapy for stroke prevention

316 Pages·2001·2.574 MB·English

by  Bogousslavsky, Julien

Drug Therapy for Stroke Prevention
Drug Therapy for Stroke
Prevention
Edited by Julien Bogousslavsky
Centre Hospitalier Universitaire
Vaudois, Lausanne,
Switzerland
London and New York
First published 2001
by Taylor & Francis
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Taylor & Francis Inc.
29 West 35th Street, New York, NY 10001
Taylor & Francis is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2005.
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© 2001 Julien Bogousslavsky
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic, mechanical,
or other means, now known or hereafter invented, including
photocopying and recording, or in any information storage or
retrieval system, without permission in writing from the publishers.
Every effort has been made to ensure that the advice and information in this
book is true and accurate at the time of going to press. However, neither the
publisher nor the authors can accept any legal responsibility or liability for any
errors or omissions that may be made. In the case of drug administration, any
medical procedure or the use of technical equipment mentioned within this
book, you are strongly advised to consult the manufacturer’s guidelines.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Drug therapy for stroke prevention/by Julien Bogousslavsky.
p. ; cm.
Includes bibliographical references and index.
1. Cerebrovascular disease-Chemoprevention. I. Bogousslavsky, Julien.
[DNLM: 1. Cerebrovascular Disorders-prevention & control.
2. Drug Therapy. 3. Primary Prevention. WL 355 D7938 2001]
RC388.5.D78 2001
616.8′1–dc21 2001027207
ISBN 0-203-21141-3 Master e-book ISBN
ISBN 0-203-26901-2 (Adobe eReader Format)
ISBN 0-7484-0934-3 (Print Edition)
Contents
List of tables vi
List of figures viii
Notes on contributors ix
1 Stroke prevention in 2001 1
JANET L.WILTERDINKJ.AND DONALD EASTON
2 Primary and secondary prevention of stroke 13
PHILIP B.GORELICK
3 Aspirin and stroke prevention 34
P.DE MOERLOOSE AND T.LECOMPTE
4 Ticlopidine and clopidogrel 48
MAURIZIO PACIARONIJULIEN BOGOUSSLAVSKY AND
VIRGILIO GALLAI
5 Other antiplatelet agents 79
ANTONIO CULEBRAS
6 Dipyridamole 87
H.C.DIENER AND C.FORBES
7 New antiplatelet strategies in stroke prevention and 94
treatment
BABETTE B.WEKSLER AND JOSE PENA-ALVAREZ
8 Clinical use of antiplatelet agents for stroke prevention 112
R.MARKUSS.KAZUIG. AND A.DONNAN
9 Investigation and management before and after carotid 135
endarterectomy
H.J.M.BARNETTHEATHER MELDRUM AND MICHAEL
ELIASZIW
10 Stroke prevention—oral anticoagulants 153
THIERRY MOULINFABRICE VUILLIER AND LAURENT
TATU
v
11 Early prevention of stroke recurrence 168
D.J.H.McCABEM. AND M.BROWN
12 Hypercholesterolemia, lipid lowering agents and the risk of 188
brain infarction
PIERRE AMARENCO
13 Stroke prevention with blood pressure control 209
JACQUES CORNUZ AND MICHEL BURNIER
14 Vitamins and antioxidants 229
J.DAVID SPENCE
15 Estrogen replacement therapy for stroke 251
LAWRENCE M.BRASS
16 Health care issues, benefits and costs 273
GRAEME J.HANKEY
Index 291
Tables
2.1 Guides for screening 14
2.2 Diagnostic technology and efficacy 15
2.3 Measures of accuracy of diagnostic tests 16
2.4 Primary prevention programs which focus on coronary heart disease 22
2.5 Key design components of AAASPS 27
3.1 Randomised, placebo–controlled trials of ASA in patients with 36
previous transient ischaemic attack or stroke
3.2 Main arguments for the use of high-dose ASA 37
3.3 Main arguments for the use of low-dose ASA 38
3.4 Benefits and risks of ASA in patients with TIA and ischaemic stroke 40
4.1 Therapeutic effectiveness of ticlopidine in TASS: intention to treat 56
analysis
4.2 Therapeutic effectiveness of ticlopidine in TASS: efficacy analysis 56
4.3 Unwanted effects of ticlopidine in TASS 57
4.4 Severe unwanted effects of clopidogrel 64
4.5 Serious adverse events in patients on ticlopidine 66
4.6 Neutropenia in patients on ticlopidine 66
6.1 Trial results of aspirin, dipyridamole (DP) and their combination 88
6.2 Patient numbers and doses of trial treatment in ESPS-2 90
6.3 Outcome measures of ESPS-2 90
6.4 Rates of strokes before treatment cessation in patients with atrial 91
fibrillation
6.5 Proportion of primary intracerebral bleedings among all strokes in 92
ESPS-2
7.1 Therapeutic agents directed at specific platelet functions 96
7.2 Antiplatelet approaches in stroke prevention considered ineffective or 98
of minimal efficacy
7.3 Novel antiplatelet strategies in stroke prevention and treatment 98
8.1 Adverse effects of ticlopidine and clopidogrel 125
9.1 Perioperative outcome events at 30 days and assessment of stroke 140
severity at 90 days
9.2 Bleeding complications in ACE 147
9.3 Primary outcome events at 3 months in ACE 148
10.1 Interactive drugs and anticoagulants 155
10.2 Main guidelines for oral anticoagulation 156
11.1 Outcome events at the end of 4 weeks in CAST 170
vii
11.2 Outcome events during the first 14 days in IST 172
11.3 Outcome events in patients randomised to heparin or “avoid heparin” 177
in IST
13.1 Definitions and classification of blood pressure for adults aged 18 210
years or over
13.2 High blood pressure prevalence and blood pressure control quality 219
13.3 Guidelines for selecting drug treatment of hypertension 222
15.1 Effects of estrogen on the vascular system 252
15.2 Effects of estrogen on the nervous system 256
16.1 Effectiveness and cost of drug therapies for primary stroke prevention 278
16.2 Effectiveness and cost of secondary stroke prevention 282
16.3 Approximate costs and effects of various drug therapies 286
Figures
4.1 Schematic diagram of platelet response to injury of a blood vessel 50
4.2 Ticlopidine hydrochloride 50
4.3 Pathway of platelet activation 50
4.4 Inhibition of fibrinogen binding to human platelets stimulated by 51
ADP
4.5 Clopidogrel 58
4.6 ADP binding sites in human platelets after oral clopidogrel 58
4.7 Inhibition of platelet aggregation by clopidogrel 59
4.8 CAPRIE results 63
4.9 Direct comparison of different antiplatelet regimens in “high-risk” 65
trials
8.1 Sites of action of platelet inhibitors 115
8.2 Relative-risk ratio for vascular events with aspirin 119
8.3 Expected stroke rates with placebo, warfarin and aspirin 122
8.4 Effect of active treatment with dipyridamole and aspirin 124
8.5 Treatment effect of clopidogrel versus aspirin 128
9.1 Risk of ipsilateral stroke over time in symptomatic patients 137
9.2 Perioperative outcome events of nonstroke death, fatal stroke and 142
nonfatal stroke
11.1 Overview of the effects of aspirin on death or dependency after 173
stroke
12.1 U-shape relationship between cholesterol and death rate from stroke 190
12.2 Cholesterol levels of patients in four major trials of lipid lowering 193
agents
13.1 Diastolic blood pressure and risk of stroke 210
14.1 Post-prandial fats are more important than fasting lipids 230
14.2 Free radical attack is a chain reaction 235
14.3 Key amino acids in homocyst(e)ine metabolism 236
14.4 Homocyst(e)ine metabolism 240
14.5 Response of carotid atherosclerosis progression to therapy with 241
folate, B and B
6 12
Notes on contributors
P.Amarenco is Professor of Neurology at Lariboisière Hospital in Paris.
H.J.M.Barnett is Professor Emeritus of Clinical Neurological Sciences at the
University of Western Ontario, and a Scientist at the John P.Robarts Reseach
Institute in London, Ontario. He has been involved as Principal or Co-Principal
Investigator in a series of multi-centre clinical trials in stroke prevention
(including the North American Symptomatic Carotid Endarterectomy Trial
and the Aspirin and Carotid Endarterectomy Trial), and has published over
200 peer-reviewed papers, most of them related to stroke prevention.
J.Bogousslavsky is Professor and Chairman of the Department of Neurology,
and Professor of Cerebrovascular Disease at the University of Lausanne,
Switzerland. His main interests include clinical neurology, localisation within
the brain, eye movement disorders, and above all cerebrovascular disease and
stroke, including clinical trials. He has published over 500 peer-reviewed
articles and is the author or editor of 25 books. He is also a permanent
representative of the World Federation of Neurology to the World Health
Organization, and acts as expert for many other international organisations.
L.M.Brass is Professor of Neurology, Professor of Epidemiology and Public
Health at Yale University School of Medicine in New Haven, Connecticut,
and Director of Cerebrovascular Research in the Center for Outcomes
Research and Evaluation (CORE) at Yale-New Haven Hospital. He is also
Chief of the Neurology Service at VA Connecticut Healthcare System. A
principal investigator for numerous studies, his research interests include
devising improved management strategies and better defining stroke risk. His
work has documented the variation in the management of stroke patients with
under-use of well-established therapies such as warfarin among patients with
atrial fibrillation and over-use of unproven therapies such as intravenous
anticoagulation among patients with acute ischemic stroke.
M.M.Brown is Foundation Professor of Stroke Medicine at the Institute of
Neurology, University College London and Consultant Neurologist at the
National Hospital for Neurology and Neurosurgery in London. He runs a
Stroke Assessment Clinic and an Acute Brain Injury Unit for stroke patients at
the National Hospital. His research interests include MR imaging and