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Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA
In a trial in China, patients with a minor stroke or transient ischemic attack with
CYP2C19
loss-of-function alleles as determined by point-of-care testing had modestly fewer second strokes with ticagrelor than with clopidogrel but also had more total bleeding events.
Journal Article
Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA
A trial involving 11,016 patients showed that the combination of ticagrelor and aspirin after a stroke or high-risk transient ischemic attack was better than aspirin alone in preventing a stroke or death within 30 days. Severe bleeding was rare but occurred more frequently in the dual antiplatelet group.
Journal Article
Things that go bump in the universe : how astronomers decode cosmic chaos
\"This new book explores the pioneering field of transient - or time-domain - astronomy, the incredible discoveries being made, the tools that we use to detect these cosmic events, and the aspects that continue to puzzle observers and theorists. In an engaging style accessible to the layperson, the astronomer and popular science author gives us an up-to-date overview of the \"transient universe,\" and explains how astronomers came to see the cosmos as a dynamic place, rather than a static one\"-- Provided by publisher.
Book
A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke
In this trial, patients with stroke or TIA and atherosclerosis who received a statin with or without ezetimibe were randomly assigned to an LDL cholesterol target of less than 70 mg per deciliter or to a target range of 90 to 110 mg per deciliter. At a median follow-up of 3.5 years, the incidence of a composite cardiovascular end point was 12% lower in the lower-target group than in the higher-target group. The incidence of cerebral hemorrhage did not differ significantly between the two groups.
Journal Article
Long-term colchicine for the prevention of vascular recurrent events in non-cardioembolic stroke (CONVINCE): a randomised controlled trial
Anti-inflammatory therapy with long-term colchicine prevented vascular recurrence in coronary disease. Unlike coronary disease, which is typically caused by atherosclerosis, ischaemic stroke is caused by diverse mechanisms including atherosclerosis and small vessel disease or is frequently due to an unknown cause. We aimed to investigate the hypothesis that long-term colchicine would reduce recurrent events after ischaemic stroke.
We did a randomised, parallel-group, open-label, blinded endpoint assessed trial comparing long-term colchicine (0·5 mg orally per day) plus guideline-based usual care with usual care only. Hospital-based patients with non-severe, non-cardioembolic ischaemic stroke or high-risk transient ischaemic attack were eligible. The primary endpoint was a composite of first fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation (defined as an admission to an inpatient unit or a visit to an emergency department that resulted in at least a 24 h stay [or a change in calendar date if the hospital admission or discharge times were not available]) for unstable angina. The p value for significance was 0·048 to adjust for two prespecified interim analyses conducted by the data monitoring committee, for which the steering committee and trial investigators remained blinded. The trial was registered at ClinicalTrials.gov (NCT02898610) and is completed.
3154 patients were randomly assigned between Dec 19, 2016, and Nov 21, 2022, with the last follow-up on Jan 31, 2024. The trial finished before the anticipated number of outcomes was accrued (367 outcomes planned) due to budget constraints attributable to the COVID-19 pandemic. Ten patients withdrew consent for analysis of their data, leaving 3144 patients in the intention-to-treat analysis: 1569 (colchicine and usual care) and 1575 (usual care alone). A primary endpoint occurred in 338 patients, 153 (9·8%) of 1569 patients allocated to colchicine and usual care and 185 (11·7%) of 1575 patients allocated to usual care alone (incidence rates 3·32 vs 3·92 per 100 person-years, hazard ratio 0·84; 95% CI 0·68–1·05, p=0·12). Although no between-group difference in C-reactive protein (CRP) was observed at baseline, patients treated with colchicine had lower CRP at 28 days and at 1, 2, and 3 years (p<0·05 for all timepoints). The rates of serious adverse events were similar in both groups.
Although no statistically significant benefit was observed on the primary intention-to-treat analysis, the findings provide new evidence supporting the rationale for anti-inflammatory therapy in further randomised trials.
Health Research Board Ireland, Deutsche Forschungsgemeinschaft (German Research Foundation), and Fonds Wetenschappelijk Onderzoek Vlaanderen (Research Foundation Flanders), Belgium.
Journal Article
Health, medicine, and the sea : Australian voyages, c.1815-1860
During the 19th century, over 1.5 million migrants set sail from the British Isles to begin new lives in the Australian colonies. Health, medicine and the sea follows these people on a fascinating journey around half the globe to give a rich account of the creation of lay and professional medical knowledge in an ever-changing maritime environment.
Book
Atrial Fibrillation in Patients with Cryptogenic Stroke
In this study, patients with cryptogenic stroke who were randomly assigned to undergo intensive ECG monitoring for 30 days had a higher incidence of detected atrial fibrillation (16%) than those assigned to receive standard 24-hour monitoring (3%).
The prevention of stroke related to atrial fibrillation is a global public health priority. Strokes due to atrial fibrillation are common and frequently devastating (70 to 80% of patients die or become disabled
1
,
2
), yet they are largely preventable with anticoagulant therapy (64% reduction in the risk of stroke and 25% reduction in mortality).
3
However, because atrial fibrillation is often intermittent and asymptomatic, it can be a silent risk factor that easily evades detection.
4
,
5
Since patients who have had a stroke or transient ischemic attack (TIA) due to atrial fibrillation face a high annual risk of stroke recurrence, . . .
Journal Article