[Inhibition of platelet aggregation and angiotensin II-receptor blockade following TIA; the unexpected results of the Prevention Regimen For Effectively Avoiding Second Strokes (PROFESS) trial].
In the Prevention Regimen for Effectively Avoiding Second Strokes (PROFESS) trial, the combination of acetylsalicylic acid (50 mg) and extended-release dipyridamole (400 mg) (ASA+Dip) was compared with clopidogrel (75 mg) in patients with a recent transient ischaemic attack (TIA) or minor disabling stroke. In the same patients, the selective type I angiotensin II-receptor blocker telmisartan (80 mg) was compared with placebo. Both comparisons did not show any benefit or harm from any of the treatments evaluated. Therefore, ASA+Dip and clopidogrel should be considered effective in secondary stroke prevention following TIA or minor disabling stroke. ASA+Dip caused headache in 6% of patients. Clopidogrel can cause severe haematological side effects in rare cases; its use is hampered mainly by its high cost. Telmisartan was well tolerated in patients with a recent TIA or minor disabling stroke but should not be used for indications other than lowering blood pressure.
Kappelle
L J
LJ
Universitaire Medisch Centrum Utrecht, afd. Neurologie, Huispost G 03.228, Postbus 85.500, 3508 GA Utrecht. l.kappelle@umcutrecht.nl
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D057912:Angiotensin II Type 2 Receptor Blockers; D001241:Aspirin / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D004176:Dipyridamole / Q000627:therapeutic use; D006261:Headache / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D020521:Stroke / Q000517:prevention & control*; D000077333:Telmisartan; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D057912:Angiotensin II Type 2 Receptor Blockers; D001562:Benzimidazoles; D001565:Benzoates; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D000077333:Telmisartan