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| |  New Guidelines For Stroke Prevention Presented PALO ALTO, CA -- January 30, 2001 -- According to the ACCP (American College of Chest Physicians) Consensus Statement 2001 on Antithrombotic and Thrombolytic Therapy for Ischemic Stroke, the antiplatelet agent, aspirin/extended-release dipyridamole 25mg/200mg, is more effective than aspirin alone and may be more effective than clopidogrel for reducing the risk of secondary stroke in patients who have already experienced a stroke or transient ischemic attack (TIA or mini-stroke). "The new ACCP stroke recommendations demonstrate that newer and more effective treatment options for stroke prevention are now available," said Dr. Gregory Albers, MD, director of the Stanford Stroke Center, Palo Alto, CA, and Chairman of the ACCP expert panel on stroke and atrial fibrillation of the 6th ACCP Consensus Conference on Antithrombotic Therapy. "New antiplatelet agents with improved efficacy over aspirin offer tremendous opportunities for stroke prevention and the reduction of stroke-related mortality and disability." The consensus statement recommends aspirin, clopidogrel, and aspirin/extended-release dipyridamole all as acceptable options for the initial therapy after stroke or TIA. The recommendations refer to the results of the European Stroke Prevention Study-2 (ESPS-2) that lend scientific support to the improved efficacy of aspirin/extended-release dipyridamole over aspirin. ESPS-2, the largest recurrent stroke prevention trial ever conducted, examined the efficacy of aspirin/extended-release dipyridamole, aspirin alone, dipyridamole alone or placebo on the risk of recurrent stroke in 6,602 patients. Results from the study demonstrate that aspirin/extended-release dipyridamole significantly reduces the risk of stroke by 37 percent compared to placebo and by 22 percent compared to aspirin alone. It was proven that the combination of aspirin and extended-release dipyridamole was almost twice as effective as aspirin alone. Each of the alternative antiplatelet agents (aspirin/extended-release dipyridamole, clopidogrel and ticlopidine) has only been compared to aspirin in large outcomes studies. Indirect comparisons, however, between the trials of these different agents suggest that aspirin/extended-release dipyridamole may be a more effective option for the prevention of secondary stroke. There are nearly four million Americans who have survived a stroke and are living with the aftereffects, and new or recurrent strokes affect more than 750,000 Americans every year. Stroke is both the third leading cause of death within the United States as well as one of the leading causes of adult disability, costing more than $30 billion per year and killing 160,000 Americans annually. Of the 570,000 stroke survivors, the cumulative risk of recurrence over five years ranges from 30 percent to almost 50 percent. An ischemic stroke occurs when a blood clot interrupts the flow of blood to an area of the brain and eventually damages that part of the brain permanently. The symptoms of a stroke are: * Sudden numbness or weakness of the face, arm or leg, especially on one side of the body, Treatments during the initial onset of ischemic stroke are designed to 'break up' the blood clot in order to restore blood flow, limiting the amount of brain damage. In addition, the first year after an acute stroke or TIA is associated with an increased risk of another stroke, and several studies consistently demonstrate that the long-term administration of antiplatelet agents reduces the risk of secondary stroke in these patients. In fact, according to the consensus statement released by the ACCP, any person, except for those with contraindications, who has experienced a stroke or TIA should be treated with antiplatelet agents in order to prevent a recurrent event. Like strokes, TIAs or mini-strokes are brief episodes of stroke symptoms that result from temporary interruptions of blood flow to the brain. Unlike strokes, however, these attacks cause no permanent neurological damage and are brief, with temporary symptoms that last anywhere from a few seconds to up to 24 hours. A TIA is often an important warning and a precursor to stroke. Survey results released earlier this year showed that the prevalence of diagnosed TIA is two times higher in America than previously thought and that 1.2 million Americans 45 and older have most likely suffered a TIA without realizing it. Coupled with the fact that approximately one-third of all people who report experiencing a TIA will go on to have a full stroke, this information underscores the importance of treating TIA patients with prophylactic measures. The new consensus statement is the sixth in a series of recommendations that the ACCP has issued on antithrombotic therapy since 1985. The recommendations were based on an exhaustive review of the scientific literature performed by an international group of experts who graded each recommendation on the basis of the weight of the scientific evidence available. The authors cautioned that the recommendations should provide general guidelines, but not replace the prerogative of physicians to make therapeutic decisions based on the risks and benefits of antithrombotic therapy for individual patients. The overall consensus statement covered a wide range of diseases and conditions for which antithrombotic therapy is indicated, including coronary artery disease, atrial fibrillation, and ischemic stroke. The statement was published as a special supplement to the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians. The ACCP represents over 15,000 members who provide clinical respiratory and cardiothoracic patient care in the United States and throughout the world.
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