Amaurosis fugax: diagnostic and therapeutic aspects.
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Sulphinpyrazone (Anturan, 200 mg four times daily) was administered orally to 10 patients for two weeks. Thrombo-elastographic determinations revealed no disturbance of coagulation and it may therefore be concluded that Anturan can also be safely administered pre-operatively.
Forty-one adult diabetic patients of either sex who had been controlled by insulin alone for at least one year were randomly allocated in a double-blind, between-patient study, to either sulphinpyrazone (600--800 mg daily) or an identnd at the end of it, no clinically or statistically significant change of the insulin needs of the patients was observed. It is concluded that no clinical interaction occurs between sulphinpyrazone (800 mg/day or 600 mg/day) and insulin when they are administered simultaneously for long periods. In the doses used the tolerability of sulphinpyrazone was very good.
Renal tolerability of a guided incremental dose schedule of sulphinpyrazone was evaluated in an open study of 2-month duration, performed in twenty-one cardiovascular elderly azotemic patients (thirteen males, eight females; mean age: 79 years, S.D.: 7 X 3 years). Starting dosage was 200 mg per day; daily dosage was then increased, every 4 days, by 200 mg or kept constant for another 4 days, according to each patient's basal renal function, up to the maintenance dose: 800 mg/day. Eighty-one per cent of the patients followed a successful incremental pathway, 9% kept a constant daily dosage of 200 mg for 8 days, reaching then the maintenance daily dose without any problems. Nine per cent withdrew at 200 mg/day because renal function deteriorated at two consecutive visits. Renal function of the patients who completed the study significantly improved (two-way ANOVA, p less than 0.01). General tolerability was good. The proposed incremental dose schedule of sulphinpyrazone can be successfully used in the treatment of cardiovascular elderly azotemic patients.
A double-blind, placebo-controlled crossover study of the effect of sulphinpyrazone on blood viscosity and its determinants (haematocrit, plasma fibrinogen and plasma viscosity) was carried out in 7 healthy male volunteers. Apart from a transient rise in fibrinogen (p less than 0.05) after 3 days of sulphinpyrazone treatment, no significant change in viscosity factors was seen over a 14-day period.
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The influence of Anturan on rosette-forming cells and hemolytic antibodies in male Wistar rats immunized with 5 . 10(8) sheep red blood cells was investigated. An unknown influence of Anturan on the cellular and humoral immune response was detected. Anturan was most effective when given 2 days after immunization.
Data from the Aspirin in Transient Ischemic Attack (AITIA) study, an ongoing study of two platelet antiaggregant drugs, and other published therapeutic trials were reviewed to determine whether the severity of stroke is reduced in patients taking platelet antiaggregants. Data from three of four studies suggest that strokes in treated patients are less severe than those in untreated patients. Further studies evaluating platelet antiaggregant therapy should include assessment of the severity as well as the incidence of stroke.
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Aspirin (325 and 900 mg/d) is effective for a period of 1 year in reducing the frequency of saphenous vein bypass graft occlusion when begun 1 day before operation or on the day of operation. Aspirin in combination with dipyridamole is not more effective than aspirin alone in the prevention of saphenous vein graft occlusion. Bleeding is higher among patients treated with aspirin (325 mg/d) than among controls if aspirin is started 1 day before operation. Bleeding in one trial was greater than controls if aspirin (300 mg/d) was started the day of operation, and in one trial there was no difference when aspirin (325 mg/d) was started the day of operation. Ticlopidine (500 mg/d), started 2 days after operation, was effective in maintaining graft patency. Oral anticoagulants were inconsistent in the maintenance of saphenous vein graft patency. The continued use of aspirin for 2 additional years after an initial year of aspirin therapy for the prevention of saphenous vein bypass graft occlusion showed no additional long-term benefit on graft patency at the end of the third year. Antithrombotic agents given to patients with internal mammary artery bypass grafts showed no benefit in comparison to placebo because patency on placebo was high.
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