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PubMed · 3285985

Transient ischemic attacks and stroke.

Abstract

Transient ischemic attacks (TIAs) constitute the most specific and powerful warnings of impending stroke. They are defined as brief, focal neurological events of sudden onset. Their proper recognition and treatment rank second only to the modification of risk factors in importance for stroke prevention. Carotid endarterectomy, although widely used to treat TIAs, remains unproven; randomized clinical trials are attempting to define its role. Anticoagulant therapy appears worth while for suspected cardiac embolism and possibly for disabling TIAs. Acetylsalicylic acid is the only agent that has been found to be effective in controlled trials, but questions persist about its dosage, its efficacy in women and its use after stroke. Another platelet inhibitor, ticlopidine hydrochloride, is being investigated and may prove to be an effective alternative.

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BibTeXRIS

T R Mirsen, V C Hachinski. 1988-06-15. Transient ischemic attacks and stroke.. https://pubmed.ncbi.nlm.nih.gov/3285985/

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Rapid desensitization protocols for patients with cardiovascular disease and aspirin hypersensitivity in an era of dual antiplatelet therapy.

OBJECTIVE: To review the available protocols for rapid desensitization of patients with aspirin hypersensitivity and apply the data for use in patients with cardiovascular disease who would benefit from the dual antiplatelet therapy. DATA SOURCES: A literature search was conducted via MEDLINE from 1966 to December 2006. Main search terms included: aspirin sensitivity, aspirin allergy, aspirin desensitization, aspirin-induced asthma, aspirin therapy, and aspirin intolerance syndrome. STUDY SELECTION AND DATA EXTRACTION: Articles describing rapid aspirin desensitization protocols were selected for review. Literature pertaining to aspirin hypersensitivity, drug desensitization, and the use of aspirin and dual antiplatelet therapy was also examined. Three rapid desensitization protocols were identified and evaluated. DATA SYNTHESIS: While landmark studies demonstrated that dual antiplatelet therapy with aspirin and clopidogrel significantly reduces mortality and morbidity in acute coronary syndromes and coronary stenting, patients with aspirin hypersensitivity are frequently managed with clopidogrel alone with no supporting data. Approximately 10% of the population experiences hypersensitivity to aspirin, which can manifest as asthma exacerbations, rhinorrhea, angioedema, urticaria, and anaphylaxis. The hypersensitivity reaction is mediated through aspirin-directed antibodies or by excessive leukotriene production. The desensitization process involved depletion of these mediators, as well as down-regulation of leukotriene receptors. Two groups of investigators developed rapid protocols to desensitize patients with aspirin hypersensitivity safely and effectively. The rapid protocol developed by Wong provides benefits over other protocols with its low starting dose and completion in less than 3 hours, low incidence of adverse effects, and high success rate in aspirin desensitization. CONCLUSIONS: The Wong protocol is an attractive option for the rapid desensitization of patients requiring dual antiplatelet therapy with aspirin and clopidogrel in the perimyocardial infarction period.

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