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Title: Antiplatelets, Telmisartan Have No Effect on Disability Due to Recurrent Stroke
URL: http://www.pslgroup.com/dg/22A33E.htm
Doctor's Guide
August 29, 2008

NEW YORK -- August 29, 2008 -- Disability due to recurrent stroke and cognitive decline in patients with ischaemic stroke was not different between 2 antiplatelet regimens and was not affected by the preventive use of telmisartan, according to a study published early online and in the October issue of Lancet Neurology.

Hans-Christoph Diener, MD, University Hospital Essen, Essen, Germany, and colleagues conducted a randomised, controlled trial including 20,332 patients (mean age, 66 years) who had had a stroke.

Of the patients who had a recurrent stroke, 916 were randomised to receive aspirin 25 mg (ASA) plus extended-release dipyridamole 200 mg BID (ER-DP), 898 to clopidogrel 75 mg QD, 880 to telmisartan 80 mg QD, and 934 to placebo.

Patients were followed up for a median of 2.4 years. The proportion of patients who had recurrent stroke was 9% in all 4 groups.

Each patient disability was assessed with 3 scores: the modified Rankin Scale (mRS) and the Barthel Index at 3 months; cognitive decline was assessed with the mini-mental state examination at 4 weeks after randomisation and at the penultimate visit. None of these measures revealed any significant differences among the 4 groups.

"Disability due to recurrent stroke and cognitive decline in patients with ischaemic stroke were not different between the 2 antiplatelet regimens and were not affected by the preventive use of telmisartan," wrote study authors. The most probable explanation is that neither ASA with ER-DP nor clopidogrel are neuroprotective, despite indications from experiments in animals that this may be the case." They added that telmisartan is also probably not neuroprotective.

In an accompanying comment, Graeme Hankey, MD, Royal Perth Hospital, Western Australia, Australia, and John Eikelboom, MD, McMaster University, Hamilton, Ontario, said: "The trial investigators are to be congratulated for completing the largest trial of its kind in the world ... Hopefully, future trials of such stature will address the remaining questions, such as what are the optimum antiplatelet and antihypertensive regimens for acute transient ischaemic attack and ischaemic stroke, and how can we accurately measure, and optimally minimise, the physical and cognitive sequelae of disabling stroke."


SOURCE: Lancet Neurology

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