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Episode 67: A clot, a clot, I want it not – secondary stroke prevention with antiplatelets

In episode 67, we address ischemic stroke of arterial origin and go over some core therapies (ASA, dipyridamole, clopidogrel and warfarin).  We also discuss complications of anti-thrombotics and the options for patients with a GI bleed on ASA.  Although Peter attempts to guide us through the maze of evidence, all three of us get lost and have trouble finding our way back. Mike rightly corrects James about one of his comments and James responds in a purely professional manner.

Show Notes

1) ASA post-stroke – low dose

ATTC 2009

Lancet 2009;373:1849–60

2) Clopidogrel versus ASA

CAPRIE

Lancet 1996;348:1329–39

3) ASA and clopidogrel versus clopidogrel

CHARISMA

NEJM 2006;354:1706-17

MATCH

Lancet 2004;364:331–37

4) ASA versus warfarin post-stroke

WARSS

NEJM 2001;345:1444-51

5) Dipyridamole plus ASA

ESPS-2

Thromb Res 1998;92:S1-S6

ESPRIT

Lancet 2006;367:1665-75

peterloewen.com

PRoFESS

NEJM 2008;359:1238-51

7) GI bleeding and ASA

PPI added to ASA versus clopidogrel alone

NEJM 2005; 352:238-44

H. pylori eradication versus proton pump inhibitor

NEJM 2001;344:967-73

H. pylori eradication plus proton pump inhibitor versus H. pylori eradication alone

NEJM 2002;346:2033-8

Clopidogrel plus a PPI – interaction or not

CMAJ 2009;180:713-8

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