Letter by Borja and García-Rafanell Regarding Article, “Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association”

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HomeStrokeVol. 42, No. 6Letter by Borja and García-Rafanell Regarding Article, “Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Borja and García-Rafanell Regarding Article, “Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association” Javier Borja, MD and Julián García-Rafanell, PhD Javier BorjaJavier Borja Search for more papers by this author and Julián García-RafanellJulián García-Rafanell Search for more papers by this author Originally published5 May 2011https://doi.org/10.1161/STROKEAHA.111.614461Stroke. 2011;42:e388Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2011: Previous Version 1 To the Editor:In “Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack,”1 the authors mention that “triflusal has been examined only in a pilot trial.” This information is not correct and is misleading for the reader. Neither the Triflusal versus Aspirin in Cerebral Infarction Prevention (TACIP) study,2 nor a meta analysis of 4 clinical trials comparing triflusal with aspirin in patients with stroke or transient ischemic attack3 were mentioned. The TACIP study, the most important study of triflusal in this kind of patient, was a randomized, double blind, parallel and multicenter clinical trial; it was performed with 2107 patients with stroke or transient ischemic attack. The patients received treatment of 600 mg triflusal once daily or 325 mg aspirin once daily. After a mean follow-up of 30.1 months, no differences between triflusal and aspirin were found for the primary composite end point of nonfatal ischemic stroke, nonfatal myocardial infarction, or vascular death (hazard ratio [HR] for triflusal vs aspirin, 1.09; 95% CI, 0.85–1.38). The incidence of major hemorrhage was significantly lower with triflusal than with aspirin (HR, 0.48; 95% CI, 0.28–0.82). The incidence of minor bleeding was 15.2% in the triflusal group and 22.1% in the aspirin group (P<0.001).The aforementioned meta analysis,3 including a total of 2994 patients with stroke or transient ischemic attack who were followed for 6 to 47 months,3 reported no significant differences between aspirin and triflusal in the risk of serious vascular events (OR for aspirin vs triflusal, 1.02; 95% CI, 0.83–1.26). Aspirin was associated with a higher risk of hemorrhage, both major (OR, 2.42; 95% CI, 1.56–3.77) and minor (OR, 1.62; 95% CI, 1.31–2.01). Based on this meta analysis, the European Stroke Organisation4 recommends triflusal as an alternative to combined aspirin and dipyridamole, or to clopidogrel alone (Class I, Level A). This recommendation is the same as that for aspirin alone. Also, triflusal is recommended for secondary stroke prevention in Conn's Current Therapy 2010.(5We recognize the complexity in performing Medical Guidelines and understand that sometimes the authors can miss information; nevertheless, it is important that the Guidelines reflect true evidence available for each one of the afoementioned treatments and drugs.Javier Borja MDJulián García-Rafanell PhD Medical Department J. Uriach y Compañía, S.A. Polígon Industrial Riera de Caldes Barcelona, SpainDisclosuresJ.B. and J.G.R. are employees of J. Uriach y Compañía, S.A., the pharmaceutical company that markets triflusal.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org).