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[PMID]:27302874
[Au] Autor:El-Ragehy NA; Yehia AM; Hassan NY; Tantawy MA; Abdelkawy M
[Ti] Título:Chemometrics Tools in Detection and Quantitation of the Main Impurities Present in Aspirin/Dipyridamole Extended-Release Capsules.
[So] Source:J AOAC Int;99(4):948-56, 2016 Jul.
[Is] ISSN:1060-3271
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Aspirin (ASP) and dipyridamole (DIP) in combination is widely used in the prevention of secondary events after stroke and transient ischemic attack. Salicylic acid is a well-known impurity of ASP, and the DIP extended-release formulation may contain ester impurities originating from the reaction with tartaric acid. UV spectral data analysis of the active ingredients in the presence of their main impurities is presented using multivariate approaches. Four chemometric-assisted spectrophotometric methods, namely, partial least-squares, concentration residuals augmented classical least-squares (CRACLS), multivariate curve resolution (MCR) alternating least-squares (ALS), and artificial neural networks, were developed and validated. The quantitative analyses of all the proposed calibrations were compared by percentage recoveries, root mean square error of prediction, and standard error of prediction. In addition, r(2) values between the pure and estimated spectral profiles were used to evaluate the qualitative analysis of CRACLS and MCR-ALS. The lowest error was obtained by the CRACLS model, whereas the best correlation was achieved using MCR-ALS. The four multivariate calibration methods could successfully be applied for the extended-release formulation analysis. The application results were also validated by analysis of the stored dosage-form solution, which showed a susceptibility of DIP esterification in the extended-release formulation. Statistical comparison between the proposed and official methods showed no significant difference.
[Mh] Termos MeSH primário: Combinação Aspirina e Dipiridamo/química
Dipiridamol/análogos & derivados
Contaminação de Medicamentos
Inibidores da Agregação de Plaquetas/química
Tartaratos/análise
[Mh] Termos MeSH secundário: Cápsulas
Dipiridamol/análise
Dipiridamol/síntese química
Análise dos Mínimos Quadrados
Redes Neurais (Computação)
Espectrofotometria
Tartaratos/síntese química
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Capsules); 0 (DIP-1 dipyridamole tartartic acid ester); 0 (Platelet Aggregation Inhibitors); 0 (Tartrates); 64ALC7F90C (Dipyridamole)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160616
[St] Status:MEDLINE
[do] DOI:10.5740/jaoacint.16-0082


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[PMID]:26154769
[Au] Autor:Ong WL; Koh TL; Fletcher J; Gruen R; Royce P
[Ad] Endereço:1 Department of Urology, Alfred Health , Prahran, Victoria, Australia .
[Ti] Título:Perioperative Management of Antiplatelets and Anticoagulants Among Patients Undergoing Elective Transurethral Resection of the Prostate--A Single Institution Experience.
[So] Source:J Endourol;29(11):1321-7, 2015 Nov.
[Is] ISSN:1557-900X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To evaluate current practice in the perioperative management of antiplatelets (AP) and anticoagulants (AC) among men undergoing elective transurethral resection of the prostate (TURP), as well as the associated perioperative bleeding and thromboembolic complications. PATIENTS AND METHODS: Retrospective review of consecutive elective TURP patients in a single tertiary institution from January 2011 to December 2013 (n = 293). Data on the regular use of AP/AC and the perioperative management approach were collected from patients' electronic medical records. Bleeding and thromboembolic complications were assessed up to 30 days postoperative. Association between AP/AC use and perioperative complications was assessed using the Kruskall-Wallis test (continuous variables) and the Fisher exact test (categoric variables). RESULTS: There were 107/293 (37%) patients receiving long-term AP while there were 25/293 (9%) patients receiving long-term AC. A total of 72/107 (67%) patients ceased AP on an average of 7.6 days preoperatively, while 35/107 (33%) continued receiving AP. Patients with coronary stents (62%) and coronary bypass graft (67%) were significantly more likely to continued receiving AP (P < 0.001). AC was ceased in all patients preoperatively, with 16/25 (64%) receiving enoxaparin bridging. Overall, there were 31 (10%) incidents of bleeding complications and 5 (2%) thromboembolic events. AC users who had enoxaparin bridging had significantly higher risk of bleeding complications (44%), compared with non-AP/AC users (8%), AP users who ceased AP (4%), AP users who continued receiving AP (17%), and AC users who did not receive enoxaparin bridging (0%) (P < 0.001). AC users who received enoxaparin bridging also reported significantly higher thromboembolic complications (17%; P < 0.001) and prolonged hospital stay (mean 5.4 days) (P = 0.002), compared with other patients. CONCLUSION: Perioperative management of AP/AC should be based on the indications and the American College of Chest Physicians thromboembolic risk stratification. Regular AC users who had enoxaparin bridging are at increased risk of both perioperative bleeding and thromboembolic complications.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Enoxaparina/uso terapêutico
Hemorragia/epidemiologia
Assistência Perioperatória/métodos
Inibidores da Agregação de Plaquetas/uso terapêutico
Complicações Pós-Operatórias/epidemiologia
Hiperplasia Prostática/cirurgia
Tromboembolia/epidemiologia
Ressecção Transuretral da Próstata
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aspirina/uso terapêutico
Combinação Aspirina e Dipiridamo/uso terapêutico
Procedimentos Cirúrgicos Eletivos
Seres Humanos
Masculino
Meia-Idade
Próstata
Estudos Retrospectivos
Ticlopidina/análogos & derivados
Ticlopidina/uso terapêutico
Vitória/epidemiologia
Varfarina/uso terapêutico
Suspensão de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Aspirin, Dipyridamole Drug Combination); 0 (Enoxaparin); 0 (Platelet Aggregation Inhibitors); 5Q7ZVV76EI (Warfarin); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1606
[Cu] Atualização por classe:161018
[Lr] Data última revisão:
161018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:150709
[St] Status:MEDLINE
[do] DOI:10.1089/end.2015.0115


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[PMID]:24789585
[Au] Autor:Buitrago I; Wolinsky D; Asher CR
[Ad] Endereço:Department of Cardiology, Cleveland Clinic Florida, Weston.
[Ti] Título:Syncope during a pharmacologic nuclear stress test.
[So] Source:Cleve Clin J Med;81(5):279-80, 2014 May.
[Is] ISSN:1939-2869
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Adenosina/efeitos adversos
Aspirina/efeitos adversos
Dipiridamol/efeitos adversos
Parada Cardíaca/induzido quimicamente
Inibidores da Agregação de Plaquetas/efeitos adversos
Compostos Radiofarmacêuticos/efeitos adversos
Síncope/induzido quimicamente
[Mh] Termos MeSH secundário: Combinação Aspirina e Dipiridamo
Combinação de Medicamentos
Interações Medicamentosas
Teste de Esforço
Feminino
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Drug Combinations); 0 (Platelet Aggregation Inhibitors); 0 (Radiopharmaceuticals); 64ALC7F90C (Dipyridamole); K72T3FS567 (Adenosine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1504
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140503
[St] Status:MEDLINE
[do] DOI:10.3949/ccjm.81a.13111


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[PMID]:24161074
[Au] Autor:Nee R; Parker AL; Little DJ; Yuan CM; Himmelfarb J; Lowe SR; Abbott KC
[Ti] Título:Cost-effectiveness of antiplatelet therapy to prolong primary patency of hemodialysis graft.
[So] Source:Clin Nephrol;81(1):38-51, 2014 Jan.
[Is] ISSN:0301-0430
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The Dialysis Access Consortium (DAC) study group previously reported that treatment with extended-release dipyridamole plus aspirin (DASA) resulted in a significant but clinically modest improvement in primary unassisted arteriovenous graft (AVG) patency. Utilizing DAC published data, the objective of this study is to evaluate the cost effectiveness of antiplatelet interventions aimed at preventing loss of primary AVG patency in hemodialysis (HD) patients. METHODS: We performed a cost-utility analysis, using a decision analysis tree model with a 12-month time horizon and a third party payer perspective. Interventions included DASA with and without concurrent aspirin, aspirin alone, and no prophylaxis. The modeled population was defined as adult (≥ 18 years of age) end-stage renal disease (ESRD) patients who had undergone placement of a new AVG in the United States. The outcomes were costs, quality-adjusted life-years (QALY), incremental cost-effectiveness ratios, and net monetary benefit. Probabilities were based upon published studies performed by the DAC Study Group while costs of medications and procedures were drawn from public sources. Utilities of health states were derived from published reports and the Short Form 6D (SF-6D) instrument. RESULTS: Aspirin alone is the most cost effective strategy for AVG pharmacologic prophylaxis, as compared to no prophylaxis or DASA with or without concurrent aspirin. The results are robust on multiple scenario analyses using both deterministic and Monte Carlo probabilistic sensitivity analyses. Accounting for both costs and QALY, using aspirin alone to prevent AVG thrombosis can potentially reduce healthcare costs by $24,679,412 per year compared to no aspirin use, at a willingness-to-pay of $50,000/ QALY. CONCLUSIONS: Aspirin monotherapy compared favorably to other strategies based on cost per QALY. Our findings support the use of aspirin prophylaxis in HD patients with a new AVG who do not have a contraindication to aspirin.
[Mh] Termos MeSH primário: Oclusão de Enxerto Vascular/prevenção & controle
Inibidores da Agregação de Plaquetas/uso terapêutico
Diálise Renal
[Mh] Termos MeSH secundário: Adulto
Derivação Arteriovenosa Cirúrgica
Aspirina/uso terapêutico
Combinação Aspirina e Dipiridamo
Análise Custo-Benefício
Dipiridamol/uso terapêutico
Método Duplo-Cego
Combinação de Medicamentos
Seres Humanos
Método de Monte Carlo
Inibidores da Agregação de Plaquetas/economia
Anos de Vida Ajustados por Qualidade de Vida
Diálise Renal/efeitos adversos
Diálise Renal/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Drug Combinations); 0 (Platelet Aggregation Inhibitors); 64ALC7F90C (Dipyridamole); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1404
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:131029
[St] Status:MEDLINE
[do] DOI:10.5414/CN108100


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[PMID]:24026956
[Au] Autor:Hamishehkar H; Valizadeh H; Alasty P; Monajjemzadeh F
[Ad] Endereço:Pharmaceutical Technology Laboratory, Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
[Ti] Título:Spray drying as a fast and simple technique for the preparation of extended release dipyridamole (DYP) microparticles in a fixed dose combination (FDC) product with aspirin.
[So] Source:Drug Res (Stuttg);64(2):104-12, 2014 Feb.
[Is] ISSN:2194-9379
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Recent advances have proven that the combinational therapy of extended release dipyridamole (DYP) and fast release aspirin (ASP) can improve clinical indices of heart failure in several vascular disorders. Although pharmaceutical industries always supported fast, simple and cost saving techniques in their productions, there is no simple reported method available for this purpose. The aim of this study was to check the possibility of preparing a FDC product, containing individual dosage units of extended release DYP microparticles and fast release ASP, using the spray-drying technique as a practice compatible with pharmaceutical industries. MATERIALS AND METHOD: Solid dispersions of DYP in different polymeric substances (ethyl cellulose, carnauba wax, and Eudragit PO 100), were prepared using the spray-drying method. The physicochemical properties and structure of the prepared microparticles were analyzed using different techniques, such as the particle size analyzer (PSA), differential scanning calorimetry (DSC), scanning electron microscopy (SEM), X ray diffraction (XRD), and USP dissolution tester. ASP tablets were prepared individually and tested according to pharmacopeia. RESULTS AND DISCUSSION: Results showed that prepared microparticles measured about 2.3 µm in size. Statistical analysis of the release data revealed that there is no significant difference in the mean release amount of the selected formulation compared to the innovative brand (Aggrenox®). CONCLUSION: Findings proposed a new formulation (F7) as an alternative to innovative brand and proved spray drying as a practice compatible with pharmaceutical industries and as a successful method for sustaining the DYP release rate from prepared microparticles in a FDC dosage form.
[Mh] Termos MeSH primário: Aspirina/química
Dipiridamol/química
Tecnologia Farmacêutica
[Mh] Termos MeSH secundário: Combinação Aspirina e Dipiridamo
Varredura Diferencial de Calorimetria
Química Farmacêutica
Preparações de Ação Retardada
Combinação de Medicamentos
Microscopia Eletrônica de Varredura
Tamanho da Partícula
Solubilidade
Difração de Raios X
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Delayed-Action Preparations); 0 (Drug Combinations); 64ALC7F90C (Dipyridamole); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1404
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130913
[St] Status:MEDLINE
[do] DOI:10.1055/s-0033-1354364


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[PMID]:23816610
[Au] Autor:Weimar C; Cotton D; Sha N; Sacco RL; Bath PM; Weber R; Diener HC
[Ad] Endereço:Department of Neurology, University of Duisburg-Essen, Essen, Germany. christian.weimar@uk-essen.de
[Ti] Título:Discontinuation of antiplatelet study medication and risk of recurrent stroke and cardiovascular events: results from the PRoFESS study.
[So] Source:Cerebrovasc Dis;35(6):538-43, 2013.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Several case control studies have reported an increased risk of cardiovascular events following discontinuation of antiplatelet agents in high-risk patients. We therefore sought to investigate the risk of recurrent stroke and cardiovascular events following discontinuation of antiplatelet study medication in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, a large randomized secondary stroke prevention study. METHODS: The recurrent stroke and cardiovascular event rates following discontinuation of aspirin plus extended-release dipyridamole (ASA + ERDP) or clopidogrel were compared to the event rates in the on-treatment populations (patients who had discontinued their antiplatelet medication due to an outcome event were kept in the on-treatment population in order not to underestimate the on-treatment stroke rate). RESULTS: In 7,212 treated ASA + ERDP patients, the stroke incidence rate for the on-treatment group was 729 strokes with an average exposure of 17,048 person-years (0.12 per 1,000 person-days). For 7,864 treated clopidogrel patients, the stroke incidence rate for the on-treatment group was 737 strokes with an average exposure of 18,715 person-years (0.11 per 1,000 person-days). ASA + ERDP was discontinued in 2,843 patients (in 57.7% due to an adverse event, 28.2% noncompliance, 1.4% loss to follow-up, 4.5% withdrawal of consent and 8.1% other/nonspecified reasons) and clopidogrel was permanently discontinued in 2,176 patients (49.0% due to an adverse event, 34.2% noncompliance, 1.8% loss to follow-up, 5.3% withdrawal of consent and 9.7% other/nonspecified reasons). Within 30 days, a recurrent stroke occurred in 31 patients (0.37 per 1,000 person-days) after discontinuation of ASA + ERDP and in 15 patients (0.24 per 1,000 person-days) after discontinuation of clopidogrel. This corresponds to an absolute excess risk of 0.77% within 30 days after discontinuation of ASA + ERDP and 0.40% within 30 days after discontinuation of clopidogrel compared with the on-treatment study populations. A combined vascular endpoint (stroke, myocardial infarction, vascular death) occurred in 68 patients (0.82 per 1,000 person-days) within 30 days after discontinuation of ASA + ERDP and in 47 patients (0.75 per 1,000 person-days) within 30 days after discontinuation of clopidogrel. This corresponds to an absolute excess risk of 2.02% within 30 days after discontinuation of ASA + ERDP and 1.83% within 30 days after discontinuation of clopidogrel compared with the on-treatment study populations. CONCLUSION: Discontinuation of antiplatelet medication after ischemic stroke should be advocated only when the risk and severity of bleeding clearly outweigh the risk of cardiovascular events.
[Mh] Termos MeSH primário: Aspirina/uso terapêutico
Dipiridamol/uso terapêutico
Inibidores da Agregação de Plaquetas/uso terapêutico
Acidente Vascular Cerebral/tratamento farmacológico
Ticlopidina/análogos & derivados
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Aspirina/administração & dosagem
Combinação Aspirina e Dipiridamo
Dipiridamol/administração & dosagem
Combinação de Medicamentos
Feminino
Seres Humanos
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/administração & dosagem
Risco
Prevenção Secundária
Acidente Vascular Cerebral/prevenção & controle
Ticlopidina/administração & dosagem
Ticlopidina/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Drug Combinations); 0 (Platelet Aggregation Inhibitors); 64ALC7F90C (Dipyridamole); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1403
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130703
[St] Status:MEDLINE
[do] DOI:10.1159/000351144


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[PMID]:23532686
[Au] Autor:Offman E; Schobelock MJ; Brickl R; VanderMaelen CP; Ehrlich J; Eisert W
[Ad] Endereço:Clinical Pharmacology Sciences, Celerion, 100 Boulevard Alexis-Nihon, Bureau (Suite) 360, Montreal, QC, H4M 2N8, Canada. elliot.offman@celerion.com
[Ti] Título:Pharmacokinetics and pharmacodynamics of the antiplatelet combination aspirin (acetylsalicylic acid) plus extended-release dipyridamole are not altered by coadministration with the potent CYP2C19 inhibitor omeprazole.
[So] Source:Am J Cardiovasc Drugs;13(2):113-20, 2013 Apr.
[Is] ISSN:1179-187X
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The fixed-dose combination of aspirin (acetylsalicylic acid) 25 mg plus extended-release dipyridamole 200 mg (ASA+ER-DP) is used for long-term secondary stroke prevention in patients who have experienced non-cardioembolic stroke or transient ischemic attack. Although the theoretical risk is low that the antiplatelet activity of ASA+ER-DP will be affected by concomitant use of a proton pump inhibitor (PPI), no formal drug-drug interaction studies have been conducted. OBJECTIVE: This study aimed to determine whether the PPI omeprazole influences the pharmacokinetic (PK) and pharmacodynamic (PD) behavior of ASA+ER-DP. STUDY DESIGN AND SETTING: This was a randomized, open-label, multiple-dose, crossover, drug-drug interaction study carried out in a clinical trial unit. PARTICIPANTS: Sixty healthy male and female volunteers aged 18-50 years were included in the study. INTERVENTION: Participants were randomized to one of two treatment sequences (ABCD or CDAB), each comprising four 7-day treatments with a washout of ≥14 days between the second and third treatments. Treatment A=ASA+ER-DP 25 mg/200 mg (Aggrenox®) twice daily (BID) alone; B=ASA+ER-DP 25 mg/200 mg BID+omeprazole (Prilosec®) 80 mg once daily (QD) following ASA+ER-DP alone for 7 days; C=omeprazole 80 mg QD alone; D=omeprazole 80 mg QD+ASA+ER-DP 25 mg/200 mg BID following omeprazole alone for 7 days. MAIN OUTCOME MEASURES: The main outcome measures were systemic PK exposure to ER-DP and ASA inhibition of arachidonic acid-induced platelet aggregation. RESULTS: Systemic exposure to ER-DP was similar with and without omeprazole, based on steady-state area under the concentration-time curve (AUC) from 0 to 12 h (AUC0-12,ss, ng·h/mL) and maximum plasma concentration (Cmax,ss, ng/mL). For the treatment comparison D versus A, the percent mean ratios were 96.38 (90% confidence interval [CI] 90.96-102.13) for AUC0-12,ss and 92.03 (86.95-97.40) for Cmax,ss. The ER-DP concentration versus time profiles were nearly superimposable. There was no effect on the PDs of the ASA component: the extent of ASA inhibition of arachidonic acid-induced platelet aggregation was almost identical with and without omeprazole, with a percent mean ratio for treatment D versus A = 99.02 (90 % CI 98.32-99.72) at 4 h after last dose. All treatments were well tolerated. CONCLUSION: The PK and PD behavior of ASA + ER-DP was not altered by concurrent administration of omeprazole.
[Mh] Termos MeSH primário: Aspirina/farmacocinética
Dipiridamol/farmacocinética
Omeprazol/farmacocinética
Inibidores da Agregação de Plaquetas/farmacocinética
Agregação Plaquetária/efeitos dos fármacos
Inibidores da Bomba de Prótons/farmacocinética
[Mh] Termos MeSH secundário: Adolescente
Adulto
Aspirina/administração & dosagem
Aspirina/efeitos adversos
Combinação Aspirina e Dipiridamo
Estudos Cross-Over
Dipiridamol/administração & dosagem
Dipiridamol/efeitos adversos
Combinação de Medicamentos
Interações Medicamentosas
Quimioterapia Combinada
Feminino
Seres Humanos
Masculino
Meia-Idade
Omeprazol/administração & dosagem
Omeprazol/efeitos adversos
Inibidores da Agregação de Plaquetas/administração & dosagem
Inibidores da Agregação de Plaquetas/efeitos adversos
Inibidores da Bomba de Prótons/administração & dosagem
Inibidores da Bomba de Prótons/efeitos adversos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Drug Combinations); 0 (Platelet Aggregation Inhibitors); 0 (Proton Pump Inhibitors); 64ALC7F90C (Dipyridamole); KG60484QX9 (Omeprazole); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1310
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130328
[St] Status:MEDLINE
[do] DOI:10.1007/s40256-013-0018-3


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[PMID]:22981273
[Au] Autor:Kinsella JA; Tobin WO; Cox D; Coughlan T; Collins R; O'Neill D; Murphy RP; McCabe DJ
[Ad] Endereço:Department of Neurology, The Adelaide and Meath Hospital, incorporating the National Children's Hospital, Trinity College Dublin, Ireland.
[Ti] Título:Prevalence of ex vivo high on-treatment platelet reactivity on antiplatelet therapy after transient ischemic attack or ischemic stroke on the PFA-100(®) and VerifyNow(®).
[So] Source:J Stroke Cerebrovasc Dis;22(7):e84-92, 2013 Oct.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of ex vivo high on-treatment platelet reactivity (HTPR) to commonly prescribed antiplatelet regimens after transient ischemic attack (TIA) or ischemic stroke is uncertain. METHODS: Platelet function inhibition was simultaneously assessed with modified light transmission aggregometry (VerifyNow; Accumetrics Inc, San Diego, CA) and with a moderately high shear stress platelet function analyzer (PFA-100; Siemens Medical Solutions USA, Inc, Malvern, PA) in a pilot, cross-sectional study of TIA or ischemic stroke patients. Patients were assessed on aspirin-dipyridamole combination therapy (n = 51) or clopidogrel monotherapy (n = 25). RESULTS: On the VerifyNow, HTPR on aspirin was identified in 4 of 51 patients (8%) on aspirin-dipyridamole combination therapy (≥ 550 aspirin reaction units on the aspirin cartridge). Eleven of 25 (44%) patients had HTPR on clopidogrel (≥ 194 P2Y12 reaction units on the P2Y12 cartridge). On the PFA-100, 21 of 51 patients (41%) on aspirin-dipyridamole combination therapy had HTPR on the collagen-epinephrine (C-EPI) cartridge. Twenty-three of 25 patients (92%) on clopidogrel had HTPR on the collagen-adenosine diphosphate (C-ADP) cartridge. The proportion of patients with antiplatelet HTPR was lower on the VerifyNow than PFA-100 in patients on both regimens (P < .001). CONCLUSIONS: The prevalence of ex vivo antiplatelet HTPR after TIA or ischemic stroke is markedly influenced by the method used to assess platelet reactivity. The PFA-100 C-ADP cartridge is not sensitive at detecting the antiplatelet effects of clopidogrel ex vivo. Larger prospective studies with the VerifyNow and with the PFA-100 C-EPI and recently released Innovance PFA P2Y cartridges (Siemens Medical Solutions USA, Inc) in addition to newer tests of platelet function are warranted to assess whether platelet function monitoring predicts clinical outcome in ischemic cerebrovascular disease.
[Mh] Termos MeSH primário: Isquemia Encefálica/tratamento farmacológico
Ataque Isquêmico Transitório/tratamento farmacológico
Inibidores da Agregação de Plaquetas/uso terapêutico
Acidente Vascular Cerebral/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Aspirina/farmacologia
Aspirina/uso terapêutico
Combinação Aspirina e Dipiridamo
Plaquetas/efeitos dos fármacos
Estudos Transversais
Dipiridamol/farmacologia
Dipiridamol/uso terapêutico
Combinação de Medicamentos
Feminino
Seres Humanos
Masculino
Meia-Idade
Projetos Piloto
Agregação Plaquetária/efeitos dos fármacos
Testes de Função Plaquetária
Ticlopidina/análogos & derivados
Ticlopidina/farmacologia
Ticlopidina/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Drug Combinations); 0 (Platelet Aggregation Inhibitors); 64ALC7F90C (Dipyridamole); A74586SNO7 (clopidogrel); OM90ZUW7M1 (Ticlopidine); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1406
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:120918
[St] Status:MEDLINE


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[PMID]:21645271
[Au] Autor:Bath P; Hogg C; Tracy M; Pocock S; Optimising the Analysis of Stroke Trials Collaboration with the Writing Committee
[Ti] Título:Calculation of numbers-needed-to-treat in parallel group trials assessing ordinal outcomes: case examples from acute stroke and stroke prevention.
[So] Source:Int J Stroke;6(6):472-9, 2011 Dec.
[Is] ISSN:1747-4949
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Number-needed-to-treat describes the magnitude of the effect of an intervention, underpins health economic analyses, and is typically calculated for binary events. Ordered categorical outcomes provide more clinical information and their analysis using ordinal approaches is usually more efficient statistically. However, to date, techniques to calculate number-needed-to-treat based on ordinal outcomes for parallel group trials have had important limitations. Aims Numbers-needed-to-treat may be calculated for ordinal data from parallel group trials by using an unmatched comparison of all subjects or by generating matched pairs of patients nested within the study. METHODS: The above approaches were assessed and compared with numbers-needed-to-treat calculated for binary outcomes using individual patient data from acute and prevention stroke trials testing the effect of interventions of varying utility and efficacy. RESULTS: Numbers-needed-to-treat were generally lower numerically for ordinal vs. binary, and matched vs. unmatched analyses, and the lowest in highly efficacious interventions: hemicraniectomy, ordinal matched 2.4 vs. ordinal unmatched 2.5 vs. binary matched 12 vs. binary unmatched 9 (one trial, 12 month outcome); alteplase, 4.5 vs. 6.6 vs. 8.4 vs. 8.4 (one trial with two parts, three-months); aspirin, 42 vs. 58 vs. 76 vs. 80 (one trial, six-months); and stroke units, 3.6-5.3 vs. 6.2 vs. 4.7-5.9 vs. 6.3-7.0 (two trials, three- to 60 months). Similar trends were seen for aspirin/dipyridamole vs. aspirin in secondary prevention, 22 vs. 20 vs. 31 vs. 31 (one trial, 24 months). CONCLUSIONS: Number-needed-to-treat may be calculated for ordinal outcome data derived from parallel group stroke trials; such numbers-needed-to-treat are lower than those calculated for binary outcomes. Their use complements the use of ordinal statistical approaches in the analysis of ordered categorical data.
[Mh] Termos MeSH primário: Projetos de Pesquisa
Acidente Vascular Cerebral/tratamento farmacológico
Acidente Vascular Cerebral/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Algoritmos
Aspirina/uso terapêutico
Combinação Aspirina e Dipiridamo
Ensaios Clínicos como Assunto
Intervalos de Confiança
Dipiridamol/uso terapêutico
Combinação de Medicamentos
Feminino
Fibrinolíticos/uso terapêutico
Seres Humanos
Masculino
Inibidores da Agregação de Plaquetas/uso terapêutico
Tamanho da Amostra
Acidente Vascular Cerebral/epidemiologia
Ativador de Plasminogênio Tecidual/uso terapêutico
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Drug Combinations); 0 (Fibrinolytic Agents); 0 (Platelet Aggregation Inhibitors); 64ALC7F90C (Dipyridamole); EC 3.4.21.68 (Tissue Plasminogen Activator); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1203
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:110608
[St] Status:MEDLINE
[do] DOI:10.1111/j.1747-4949.2011.00614.x


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[PMID]:21502757
[Au] Autor:Uchiyama S; Ikeda Y; Urano Y; Horie Y; Yamaguchi T
[Ad] Endereço:Department of Neurology, Tokyo Women's Medical University, Japan. suchiyam@nij.twmu.ac.jp
[Ti] Título:The Japanese aggrenox (extended-release dipyridamole plus aspirin) stroke prevention versus aspirin programme (JASAP) study: a randomized, double-blind, controlled trial.
[So] Source:Cerebrovasc Dis;31(6):601-13, 2011.
[Is] ISSN:1421-9786
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite improvements in treatment, stroke still carries a high death toll and disability in Asia. Extended-release dipyridamole (ER-DP) plus acetylsalicylic acid (ASA) has consistently been shown to be superior over conventional platelet inhibition by ASA. ER-DP plus ASA is well established in the secondary prevention of stroke in a lot of countries including the USA and Europe. DP has an established benefit in the treatment of heart disease in Japan; however, for the prevention of stroke, the fixed-dose combination of ER-DP plus ASA has only been investigated in a small number of patients in Japan. METHODS: The aim of this double-blind, randomized clinical trial was to investigate the efficacy and safety of ER-DP plus ASA versus 81 mg ASA over 1 year. The primary end point of this study was the event rate of recurrent ischemic stroke (fatal or nonfatal) using the Kaplan-Meier method and Cox regression analysis. RESULTS: Of the 1,294 enrolled patients, the primary end point was analyzed in 652 patients in the ER-DP plus ASA group and 639 in the ASA group. The incidence of ischemic stroke was 6.9% for ER-DP plus ASA and 5.0% for ASA with a hazard ratio of 1.47 (95% confidence interval 0.93-2.31) for the primary end point. The ASA treatment group was found to have a lower than expected yearly event rate, compared to other studies in Japanese stroke patients. Noninferiority of ER-DP plus ASA versus ASA could not be shown. The risks of major bleeding events and intracranial hemorrhage were found to be similar between the treatment arms. There were 4 deaths (0.6%) in the ER-DP plus ASA group and 10 (1.6%) in the ASA group. CONCLUSIONS: The results of the study are inconclusive. Noninferiority of ER-DP plus ASA versus ASA could not be established, a difference between treatments could not be shown for the primary end point. Possible reasons for this result include a small sample size, low event rates and too short a treatment duration (ClinicalTrials. gov number, NCT00311402).
[Mh] Termos MeSH primário: Aspirina/administração & dosagem
Isquemia Encefálica/prevenção & controle
Dipiridamol/administração & dosagem
Inibidores da Agregação de Plaquetas/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos
Aspirina/efeitos adversos
Combinação Aspirina e Dipiridamo
Isquemia Encefálica/etnologia
Isquemia Encefálica/mortalidade
Preparações de Ação Retardada/administração & dosagem
Preparações de Ação Retardada/efeitos adversos
Dipiridamol/efeitos adversos
Método Duplo-Cego
Combinação de Medicamentos
Feminino
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Inibidores da Agregação de Plaquetas/efeitos adversos
Modelos de Riscos Proporcionais
Acidente Vascular Cerebral/etnologia
Acidente Vascular Cerebral/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Aspirin, Dipyridamole Drug Combination); 0 (Delayed-Action Preparations); 0 (Drug Combinations); 0 (Platelet Aggregation Inhibitors); 64ALC7F90C (Dipyridamole); R16CO5Y76E (Aspirin)
[Em] Mês de entrada:1109
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:110420
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1159/000327035



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