Was GSK1349572 Actually Worth The Pounds?

Although studies focusing on lacunar infarction are rare, the benefits of various antiplatelets are considered similar between lacunar and non-lacunar infarction.92,93,94,95 The SPS3 trial is the only study to focus on lacunar infarction.81 Investigators enrolled 3,020 patients with lacunar infarction from North America, South America, and Spain. Patients were allocated to receive aspirin 325 mg plus clopidogrel 75 mg or aspirin 325 mg only. The trial was prematurely stopped due to increased mortality of those assigned to the combination therapy. After the mean follow-up of 3.4 years, the annual recurrent stroke rate was 2.5% in patients on dual therapy versus 2.7% in those taking aspirin only. The incidence of major hemorrhage in the dual therapy group was significantly Selleckchem GSK1349572 (PSAR1B Currently, aspirin, aspirin plus dipyridamole, and clopidogrel are considered acceptable options.87 An increased risk of bleeding is the primary concern when antiplatelets are used in stroke patients, especially those with SVD. In this sense, this website the two drugs cilostazol and triflusal deserve attention. Results from animal96 and human97,98 studies showed that cilostazol causes fewer bleeding complications than aspirin. Bleeding time-which reflects in vivo physiological hemostasis-was prolonged by aspirin or clopidogrel but not by cilostazol. Moreover, an increase in bleeding time was not observed when cilostazol was co-administered with aspirin or clopidogrel in patients with peripheral arterial disease.99 Moreover, cilostazol has an endothelial protective effect and prevents blood-brain barrier disruption in the ischemic brain.96,100 In a murine stroke model, cilostazol was shown to protect microvasculature in the ischemic brain by reducing matrix metalloproteinase-9 activity.101 In the sub-group analysis of the Cilostazol for Prevention of Secondary Stroke study, a significant difference between the cilostazol and aspirin groups was observed with respect to the incidence of hemorrhagic stroke in patients with lacunar stroke.102 Therefore, cilostazol seems to be safer than aspirin in terms of the risk of hemorrhagic stroke in hypertensive patients with SVD.102 Moreover, as discussed before, arterial stiffening might expose cerebral small vessels to high pulsatile pressure, hence contributing to the pathogenesis of WMH.