Neurology Medical News about antiplatelet treatment;large randomized clinical trials;prevention after transient ischemic attack

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Patients enrolled in large randomized clinical trials of antiplatelet treatment for prevention after transient ischemic attack or ischemic stroke are not representative of patients in clinical practice. The Netherlands Stroke Survey
Stroke, 06/30/09

Maasland L et al. – Data confirm that pts with ischemic attack and stroke in randomized clinical trials are only partially representative of pts in clinical practice. Use of less strict enrollment criteria may enhance "generalizability" and result in more efficient selection of pts for randomized clinical trials.

Methods

Estimate of the eligibility for participation in landmark trials of antiplatelet drugs of an unselected group of pts with stroke or transient ischemic attack from a national stroke survey
Prospective study of 972 pts transient ischemic attack or ischemic stroke from Netherlands Stroke Survey
Application of 7 large antiplatelet trials' enrollment criteria

Results

In total, 886 pts discharged alive and available for secondary prevention
Mean follow-up: 2.5 yrs
Annual rate of transient ischemic attack, stroke, or nonfatal myocardial infarction: 6.7%
Proportion of pts fulfilling trial enrollment criteria: 25%-67%
Mortality significantly higher in ineligible pts (27%-41%) than in pts fulfilling enrollment criteria (16%-20%)
Rates of vascular events not higher in trial-eligible pts than in ineligible pts

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