Bizarre, en effet. Aux nouvelles hier, ils annonçaient que la Cour
Supreme du Canada avait interdit la vente du générique du Plavix au
Canada. Question de brevet je crois. La pilule ne sortira pas de la
liste des Rx 'a justifier' pour un petit bout de temps encore.
Claude
Envoyé de mon iPhone
Le 08-11-05 à 08:52, Alain Vadeboncoeur
<[EMAIL PROTECTED]> a écrit :
Remarquez la dose utilisée: clopidogrel 75 mg bid
Alain
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Éq
uipe éditoriale de amc.ca
Sent: 5 novembre 2008 06:50
To: [EMAIL PROTECTED]
Subject: InfoPOEM: Aspirin + dipyridamole = clopidogrel for
recurrent stroke prevention (PROFESS)
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Aspirin + dipyridamole = clopidogrel for recurrent stroke prevention
(PROFESS)
Clinical question
What is the best approach to the prevention of recurrent stroke?
Bottom line
Aspirin plus dipyridamole is similarly effective to clopidogrel for
the prevention of recurrent stroke. The risk of intracerebral
hemorrhage is slightly lower with clopidogrel, and headache is more
common with aspirin plus dipyridamole. (LOE = 1b)
Reference
Sacco RL, Diener HC, Yusuf S, et al, for the Prevention Regimen for
Effectively Avoiding Second Strokes (PRoFESS) study group. Aspirin
and extended-release dipyridamole versus clopidogrel for recurrent
stroke. N Engl J Med 2008;359(12):1238-1251.
Study design
Randomized controlled trial (double-blinded)
Funding
Industry
Allocation
Concealed
Setting
Outpatient (any)
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Synopsis
Antiplatelet agents such as aspirin, clopidogrel, and aspirin plus
extended-release dipyridamole (APERD) all reduce the risk of
recurrent stroke. Direct comparisons have shown small benefits of
both APERD and clopidogrel over aspirin alone, while aspirin plus
clopidogrel is no more effective and increases the risk of bleeding.
Researchers recruited 20,332 patients older than 55 years with an
ischemic stroke in the previous 90 days; they also enrolled patients
aged 50 years to 54 years or within 90 days to 120 days if they also
had at least 2 additional vascular risk factors. Patients were
randomly assigned to receive aspirin 25 mg plus dipyridamole 200 mg
twice daily or clopidogrel 75 mg twice daily and were followed up
for a mean of 2.5 years. This was a 2x2 factorial design, so
patients were also assigned to telmisartan or placebo, but those
results are not reported in this article. The mean age of
participants was 66 years, 36% were women, and 58% were white. The
primary outcome was recurrent stroke as adjudicated by an
independent monitoring team. The analysis was by intention to treat,
and this was a noninferiority trial (ie, they were trying to prove
that APERD was at least as good as clopidogrel, not
that it was better). This was the case, as there was no difference
between groups in the primary outcome of recurrent stroke (9.0%
receiving APERD, 8.8% receiving clopidogrel), in all-cause mortality
(7.3% vs 7.4%), or in a composite outcome of stroke, myocardial
infarction, or vascular death (13.1% for both groups). Major
hemorrhage was slightly more common in the APERD group (4.1% vs
3.6%; P = .05; number needed to treat to harm [NNTH] = 200 over 2.5
years), as was intracranial hemorrhage (1.4% vs 1.0%; NNTH = 250
over 2.5 years). Headache was a more common side effect among
patients taking APERD than among those taking clopidogrel (30% vs
7%), and patients taking APERD were more likely to discontinue the
study medication than were patients taking clopidogrel (5.9% vs
0.9%; NNTH = 20).
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