CAPRIE Study Research Articles

Eosinopenia in patients with acute myocardial infarction- longitudinal imaging insights from the CAPRI study

Eosinopenia in patients with acute myocardial infarction- longitudinal imaging insights from the CAPRI study

Ceftazidime-avibactam alone or in combination with Aztreonam versus Polymyxins in the management of carbapenem-Resistant Klebsiella pneumoniae nosocomial Infections (CAPRI study): a retrospective cohort study from South India.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections commonly cause hospital-acquired infections. The study aimed to compare the outcomes of CRKP infections between patients receiving ceftazidime avibactam +/-aztreonam and polymyxins in a hospital setting with a high prevalence of New Delhi Metallo Beta Lactamase production. We conducted a retrospective cohort study from January 2020 to September 2022 in critically ill adult patients admitted to a non-COVID-19 medical intensive care unit with CRKP infection. The patients were followed up for a total of 30days or death, whichever was later. Of a total of 106 patients included in the study, 65 patients received polymyxins and 41 patients received ceftazidime-avibactam +/- aztreonam. Higher 30-day mortality was noted in the polymyxin group (56.9% vs. 29.2%, P = 0.005). The mean time to event (mortality) in ceftazidime-avibactam +/- aztreonam was 23.9 + 1.5days which was significantly higher compared to polymyxins (17.9 + 1.2days, p = 0.006). On Cox regression analysis, after adjusting for the covariates, the hazard ratio for time to event with the use of polymyxin was 2.02 (95% CI: 1.03-3.9). Ceftazidime-avibactam + aztreonam is possibly associated with better clinical outcomes in patients infected with CRKP.

The Ambulatory Medical Assistance (AMA) programme during active-phase treatment in patients with haematological malignancies: A cost-effectiveness analysis.

The need for patient navigator is growing, and there is a lack of cost evaluation, especially during survivorship. The objective of this study is to evaluate the cost-effectiveness of an Ambulatory Medical Assistance (AMA) programme in patients with haematological malignancies (HM). A cost-effectiveness analysis of the AMA programme was performed compared to a simulated control arm. An interventional, single-arm and prospective study was conducted in a French reference haematology-oncology centre between 2016 and 2020. Adult patients were enrolled with histologically documented malignant haematology, during their active therapy phase, and treated either by intravenous chemotherapy or oral therapy. An extrapolation of the effectiveness was derived from a similar nurse monitoring programme (CAPRI study). Cost effectiveness of the programme was evaluated through adverse events of Grade 3 or 4 avoided in different populations. Included patient (n = 797) from the AMA programme were followed during 125 days (IQR: 0-181), and adverse events (Grade 3/4) were observed in 10.1% of patients versus 13.4% in the simulated control arm. The overall cost of AE avoided was estimated to €81,113, leading to an ICER of €864. The AMA programme was shown to be cost-effective compared to a simulated control arm with no intervention.

Abstract CT201: Ceralasertib and olaparib in the treatment of homologous recombination repair (HRR)-deficient platinum-sensitive ovarian cancer after progression on PARP inhibitors

Abstract Background: The majority of BRCA-mutant or HRR-deficient ovarian cancers are initially sensitive to PARP inhibitors (PARPis) but eventually develop resistance. The most commonly reported PARPi resistance mechanisms are (1) reversal of HRR deficiency through (a) reversion mutations in BRCA or other HRR genes (eg, RAD51C/D) or (b) DNA end resection rewiring with loss of 53BP1, REV7, or Shieldin complex components; or (2) stabilization of stalled replication forks through loss of PTIP or EZH2, preventing nuclease recruitment. The only confirmed PARPi resistance mechanism in the clinic to date is reversion mutations. Combined ATR and PARP inhibition is an attractive strategy that may overcome PARPi resistance, as has been shown in PARPi-resistant cell lines and patient-derived xenograft models (Yazinski et al Genes Dev 2017; Murai et al Oncotarget 2016; Kim et al Nat Commun 2020; data on file, AstraZeneca). The PARPi olaparib 300 mg twice daily (BID) continuously in combination with the ATR inhibitor ceralasertib 160 mg daily on days 1-7 of a 28-day cycle has demonstrated promising activity in the CAPRI study in patients with ovarian cancer who had progressed on PARPis (Wethington et al J Clin Oncol 2021). However, preclinical models of PARPi resistance suggest that a higher dose or duration of ceralasertib with a lower dose of olaparib may be more beneficial (data on file, AstraZeneca). Methods: D5330C00004 (NCT02264678) is a multicenter, modular, phase 1 study assessing ceralasertib in combination with other anti-cancer agents in adults with advanced solid malignancies. In Module 2, a lower dose of olaparib (150 mg BID continuous) and a longer duration of ceralasertib (80 mg BID, days 1-14 of a 28-day cycle) is now being explored in 2 expansion cohorts in patients with platinum-sensitive, high-grade, serous or endometrioid ovarian, fallopian tube, or primary peritoneal cancer with deleterious or suspected deleterious germline or somatic BRCA or RAD51C/D mutations, or HRR deficiency by Myriad MyChoice® or FoundationOne® CDx (F1CDx) assays. Patients will have progressed on prior PARPis after ≥6 months in the maintenance or treatment setting (≥12 months after first-line maintenance). Cohort 1 is enrolling ~30 patients immediately after progression on a PARPi; Cohort 2 is recruiting ~30 PARPi-treated patients after intervening platinum-based chemotherapy. Study endpoints include safety, tumor response by RECIST 1.1, and duration of response. Exploratory analyses include genomic and functional analysis of HRR restoration in tumor and circulating tumor DNA, and analysis of replication fork stability in organoid cultures established from mandatory fresh tumor biopsy samples. Recruitment began in July 2021 with the first patient dosed in August 2021. Citation Format: Geoffrey I. Shapiro, Bristi Basu, Anthony El-Khoueiry, Sophie Postel-Vinay, Seock-Ah Im, Sun Young Rha, Claire F. Friedman, Antoine Italiano, Yong Man Kim, Myong Cheol Lim, Rene Roux, Joyce F. Liu, Elhan Sanai, Simon A. Smith, Claire Smith, Sarah El Farhi, Alan Lau, Natalia Lukashchuk, Emma Dean, Matthew G. Krebs. Ceralasertib and olaparib in the treatment of homologous recombination repair (HRR)-deficient platinum-sensitive ovarian cancer after progression on PARP inhibitors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT201.

5 Conservative treatment for PAD - Risk factor management.

5 Conservative treatment for PAD - Risk factor management.

Effect of CArbocisteine in Prevention of exaceRbation of chronic obstructive pulmonary disease (CAPRI study): An observational study

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a chronic and progressive lung disease characterized by irreversible airflow obstruction, airway inflammation, oxidative stress and, often, mucus hypersecretion. The aim of this study is to determine if carbocisteine, a mucolytic and antioxidant agent, administered daily for 12 months, can reduce exacerbation frequency in COPD patients. MethodsThis observational study was conducted in Naples (population approximately 1000,000), Italy. It included 85 out-patients (mean age of 67.8 ± 8.6 years) followed by Clinic of Respiratory Diseases of the University Federico II. Every patient underwent spirometry demonstrating airflow obstruction not fully reversible according to ERS/ATS criteria for COPD diagnosis (Tiffenau index less than 70% after administration of salbutamol, a beta2 agonist drug). Patients enrolled had diagnosed COPD since 2 years and suffered at least one exacerbation in the previous year. None of the patients had been treated with carbocisteine or other mucolytic agent for a longer period of time than 7 days and no more than 4 times in the previous year to the enrollment. All of them assumed daily 2.7 g of carbocisteine lysine salt for a year in addition to their basic therapy. ResultsThe comparison of exacerbation frequency between the previous year (T0) and the end of study treatment (T12), documents a statistically significant reduction of exacerbations(number of exacerbations at T0: 2 [1,3] vs number of exacerbations at T12: 1 [1,2]; p < 0.001).Quality of life was also reported and showed a statistically significant improvement at the end of the study (p < 0.001).We did not find correlation between reducing exacerbation frequency and exposure to cigarette smoking, passive smoking exposure in childhood, the use of inhaled steroids, the level of education of our patients and the GOLD stadium. InterpretationDaily administration of a mucolytic drug such as carbocisteine for prolonged periods in addition to the bronchodilator therapy can be considered a good strategy for reducing exacerbation frequency in COPD.

CT perfusion and angiographic assessment of pial collateral reperfusion in acute ischemic stroke: the CAPRI study

BackgroundThe purpose of this study was to evaluate the correlation between a novel angiographic score for collaterals and CT perfusion (CTP) parameters in patients undergoing endovascular treatment for acute ischemic...

PCV78 - Pharmacoeconomic Evaluation Acceptability of Clopidogrel Versus Acetylsalicylic Acid in Patients with Cardiovascular Disease for Stroke Prevention in Ukraine

The results of many clinical trials demonstrate the benefit of long-term antiplatelet therapy in reducing the risk of cardio- and cerebrovascular complications. Both acetylsalicylic acid (ASA) and clopidogrel are effective, but have potentially serious side effects, and clopidogrel is more expensive than ASA. The purpose of the study is to evaluate the pharmacoeconomic acceptance of clopidogrel versus ASA in patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease to prevent non-fatal stroke and death rate according to the clinical trial CAPRIE from Ukrainian perspective. Outcomes of the clinical study CAPRIE, modeling “decision tree” and analysis “cost-effectiveness” were used. The results of the clinical trial CAPRIE study showed, that clopidogrel is more effective versus ASA for reducing the risk of nonfatal stroke: absolute risk reduction is -2.7%. Model “decision tree” was built using the probabilities of events (nonfatal stroke and death) from the study CAPRIE. Direct costs were calculated taking into account the costs of antiplatelet therapy, of nonfatal stroke treatment (drugs, diagnosis, patient’s stay in hospital) and the cost of rehabilitation after stroke. Indirect costs are not taken into account because the patients were of retirement age (62.5 years old). As a result of calculations it was found, that antiplatelet therapy with clopidogrel is more expensive and more effective (2 additional lives saved per 1000 patients over 1.91 years) compared with ASA. Due to the threshold of society “willingness to pay” per 1 life saved, or 1 QALY, use of clopidogrel as antiplatelet agent in patients with cardiovascular disease is economically profitable for Ukraine. The use of clopidogrel as an antiplatelet agent in patients with cardiovascular disease to prevent nonfatal stroke compared to the ASA is economically profitable for Ukraine.

Prevalence and severity of renal dysfunction among 1062 heart transplant patients according to criteria based on serum creatinine and estimated glomerular filtration rate: results from the CAPRI study

Chronic kidney disease (CKD) is staged on the basis of glomerular filtration rate; generally, the MDRD study estimate, eGFR, is used. Renal dysfunction (RD) in heart transplant (HT) patients is often evaluated solely in terms of serum creatinine (SCr). In a cross-sectional, 14-center study of 1062 stable adult HT patients aged 59.1±12.5 yr (82.3% men), RD was graded as absent-or-mild (AoM), moderate, or severe (this last including dialysis and kidney graft) by two classifications: SCr-RD (SCr cutoffs 1.6 and 2.5 mg/dL) and eGFR-RD (eGFR cutoffs 60 and 30 mL/min/1.73 m2). SCr-RD was AoM in 68.5% of patients, moderate in 24.9%, and severe in 6.7%; eGFR-RD, AoM in 38.6%, moderate in 52.2%, severe in 9.2%. Among patients evaluated <2.7, 2.7-6.2, 6.2-9.5 and >9.5 yr post-HT (the periods defined by time-since-transplant quartiles), AoM/moderate/severe RD prevalences were <2.7, SCr-RD 74/21/5%, eGFR-RD 47/47/6%; 2.7-6.2, SCr-RD 73/22/5%, eGFR-RD 37/56/7%; 6.2-9.5, SCr-RD 69/24/7%, eGFR-RD 37/54/9%; >9.5, SCr-RD 58/32/10%, eGFR-RD 32/52/16%. The prevalence of severe RD increases with time since transplant. If the usual CKD stages are appropriate for HT patients, the need for less nephrotoxic immunosuppressants and other renoprotective measures is greater than is suggested by direct SCr-based grading, which should be abandoned as excessively insensitive.

Risk factors associated with moderate‐to‐severe renal dysfunction among heart transplant patients: results from the CAPRI study

The longer survival of patients with heart transplantation (HT) favors calcineurin inhibitor-related chronic kidney disease (CKD). It behoves to identify risk factors. At 14 Spanish centers, data on 1062 adult patients with HT (age 59.2 ± 12.3 yr, 82.5% men) were collected at routine follow-up examinations. Glomerular filtration rate, GFR, was estimated using the four-variable MDRD equation, and moderate-or-severe renal dysfunction (MSRD) was defined as K/DOQI stage 3 CKD or worse. Time since transplant ranged from one month to 22 yr (mean 6.7 yr). At assessment, 26.6% of patients were diabetic and 63.9% hypertensive; 53.9% were taking cyclosporine and 33.1% tacrolimus; and 61.4% had MSRD. Among patients on cyclosporine or tacrolimus at assessment, multivariate logistic regression identified male sex (OR 0.44), pre- and post-HT creatinine (2.73 and 3.13 per mg/dL), age at transplant (1.06 per yr), time since transplant (1.05 per yr), and tacrolimus (0.65) as independent positive or negative predictors of MSRD. It is concluded that female sex, pre- and one-month post-HT serum creatinine, age at transplant, time since transplant, and immunosuppression with cyclosporine rather than tacrolimus may all be risk factors for development of CKD ≥ stage 3 by patients with HT.

567: Risk Factors Associated with Moderate to Severe Renal Failure in Heart Transplant Patients. CAPRI Study

567: Risk Factors Associated with Moderate to Severe Renal Failure in Heart Transplant Patients. CAPRI Study

Atherothrombosis and the Management of the Vulnerable Vascular Patient

Atherothrombosis is a generalized and diffuse progressive process manifesting in multiple vascular beds leading to acute coronary syndrome (ACS), ischemic stroke, and peripheral arterial disease. The American Heart Association estimates the prevalence of ischemic stroke, coronary heart disease, and peripheral artery disease to be 4.8, 13.2, and 8 million, respectively. According to the World Health Organization, in 2004, atherothrombosis was the leading cause of death worldwide. Twenty-two percent of all deaths are attributed to atherothrombosis, which is greater than the percentage of deaths from AIDS and cancer combined. Data from the Framingham Heart Study has shown atherothrombosis significantly reduces life expectancy. According to current data, there is an established relationship among coronary artery disease, peripheral vascular disease, and cardiovascular disease. The REACH registry demonstrated that the 1-year cardiovascular event rates increase with the number of symptomatic disease locations. Unstable angina/non-ST-segment elevation MI is a major public health problem and represents the most common reason for hospital admission for coronary heart disease. Classification of "vulnerable patients" will help identify those with a high probability of developing cardiac events in the near future, and their early detection and treatment would help 50 to 60 million Americans over the age of 35. The management of patients with ischemic coronary disease consists of 2 approaches: revascularization and systemic (aspirin, clopidogrel, lipid-lowering therapy, angiotensin-converting enzyme inhibitors, and β-blockers). There is a substantial long-term cardiovascular risk after discharge with non-ST-elevation acute coronary syndrome with an annual mortality rate estimated at 6%. This emphasizes the importance of risk stratification and aggressive management strategies that target high-risk patients. Based on CAPRIE study and Cure trial results, patients can benefit from clopidogrel or its combination with aspirin. CRUSADE registry data reveal some acute medications are still being underused, most notably GP IIb/IIIa inhibitors (47%) and clopidogrel (54%). Improved American College of Cardiology/American Heart Association guideline adherence is directly associated with reduced in-hospital mortality, and thus the need for quality improvement is imperative.

Clopidogrel in Secondary Ischemic Stroke Prevention

The results obtained in the CAPRIE study in 1996 led to the introduction of the clopidogrel as a new antiplatelet drug in the secondary prevention of acute myocardial infarct (AMI), ischemic stroke (IS) and symptomatic peripheral artery disease (PAD). Clopidogrel showed a similar efficacy and safety than acetylsalicylic acid (ASA). More recently, the combined use of clopidogrel with ASA has evidenced a better protection than ASA alone in some patients: patients with past history of AMI, angina pectoris, intermittent claudication or PAD, IS or TIA, coronary bypass, and diabetes mellitus, patients on treatment with statins, and patients with symptomatic carotid stenosis >/=50%. We review the reported evidence on the efficacy of clopidogrel in the secondary prevention of ischemic stroke.

Clopidogrel

Clopidogrel

Phase III trial of postoperative cisplatin, interferon alpha-2b, and 5-FU combined with external radiation treatment versus 5-FU alone for patients with resected pancreatic adenocarcinoma – CapRI: study protocol [ISRCTN62866759

After surgical intervention with curative intention in specialised centres the five-year survival of patients with carcinoma of the exocrine pancreas is only 15%. The ESPAC-1 trial showed an increased five-year survival of 21% achieved with adjuvant chemotherapy. Investigators from the Virginia Mason Clinic have reported a 5-year survival rate of 55% in a phase II trial evaluating adjuvant chemotherapy, immunotherapy and external-beam radiation.DesignThe CapRI study is an open, controlled, prospective, randomised multi-centre phase III trial. Patients in study arm A will be treated as outpatients with 5-Fluorouracil; Cisplatin and 3 million units Interferon alpha-2b for 5 1/2 weeks combined with external beam radiation. After chemo-radiation the patients receive continuous 5-FU infusions for two more cycles. Patients in study arm B will be treated as outpatients with intravenous bolus injections of folinic acid, followed by intravenous bolus injections of 5-FU given on 5 consecutive days every 28 days for 6 cycles. A total of 110 patients with specimen-proven R0 or R1 resected pancreatic adenocarcinoma will be enrolled. An interim analysis for patient safety reasons will be done one year after start of recruitment. Evaluation of the primary endpoint will be performed two years after the last patients' enrolment.DiscussionThe aim of this study is to evaluate the overall survival period attained by chemo-radiotherapy including interferon alpha 2b administration with adjuvant chemotherapy. The influence of interferon alpha on the effectiveness of the patients' chemoradiation regimen, the toxicity, the disease-free interval and the quality of life are analysed. Different factors are tested in terms of their potential role as predictive markers.

Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial

Clopidogrel was superior to aspirin in patients with previous manifestations of atherothrombotic disease in the CAPRIE study and its benefit was amplified in some high-risk subgroups of patients. We aimed to assess whether addition of aspirin to clopidogrel could have a greater benefit than clopidogrel alone in prevention of vascular events with potentially higher bleeding risk. We did a randomised, double-blind, placebo-controlled trial to compare aspirin (75 mg/day) with placebo in 7599 high-risk patients with recent ischaemic stroke or transient ischaemic attack and at least one additional vascular risk factor who were already receiving clopidogrel 75 mg/day. Duration of treatment and follow-up was 18 months. The primary endpoint was a composite of ischaemic stroke, myocardial infarction, vascular death, or rehospitalisation for acute ischaemia (including rehospitalisation for transient ischaemic attack, angina pectoris, or worsening of peripheral arterial disease). Analysis was by intention to treat, using logrank test and a Cox's proportional-hazards model. 596 (15.7%) patients reached the primary endpoint in the group receiving aspirin and clopidogrel compared with 636 (16.7%) in the clopidogrel alone group (relative risk reduction 6.4%, [95% CI -4.6 to 16.3]; absolute risk reduction 1% [-0.6 to 2.7]). Life-threatening bleedings were higher in the group receiving aspirin and clopidogrel versus clopidogrel alone (96 [2.6%] vs 49 [1.3%]; absolute risk increase 1.3% [95% CI 0.6 to 1.9]). Major bleedings were also increased in the group receiving aspirin and clopidogrel but no difference was recorded in mortality. Adding aspirin to clopidogrel in high-risk patients with recent ischaemic stroke or transient ischaemic attack is associated with a non-significant difference in reducing major vascular events. However, the risk of life-threatening or major bleeding is increased by the addition of aspirin.

Editorial Comment—An Approach to the Estimation of the Risk of TTP During Clopidogrel Therapy

In this issue of Stroke , Zakarija and 12 co-authors1 describe 37 cases of thrombotic thrombocytopenic purpura (TTP) that occurred in the United States in the years 1998 to 2002 in association with clopidogrel (Plavix) therapy. This is of interest to those of us who (as characterized by Donnan and Davis2) are “strokologists,” since it raises questions about our understanding of the CAPRIE study.3 In CAPRIE there were 25 cases of platelet counts <100 000 per mm3 in 9553 patients receiving clopidogrel 75 mg/d, and 25 cases in 9546 patients receiving aspirin 325 mg/d (2.6 cases per thousand with each treatment); no cases of TTP were reported. We pose 2 questions: (1) Why did Zakarija et al find cases of TTP while the CAPRIE investigators did not? (2) Can we estimate the true risk of TTP during clopidogrel therapy? With regard to the first question, a possible explanation is that TTP occurs late in clopidogrel treatment, and was not seen in CAPRIE because treatment duration was too short. This explanation fails for 2 reasons: (1) Zakarija et al found that TTP occurred within the first 30 days in 87.5% of cases, and …

Management of Atherothrombosis with Clopidogrel in High-Risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke (MATCH): Study Design and Baseline Data

Background: The CAPRIE study showed the superiority of clopidogrel over acetylsalicylic acid (ASA) for reducing the combined risk of major atherothrombotic events in patients with recent myocardial infarction (MI), recent ischaemic stroke (IS) or established peripheral arterial disease. The benefit of clopidogrel over ASA is amplified in high-risk patients. Proof of concept for the benefit of clopidogrel in addition to ASA in patients with coronary manifestations of atherothrombosis was provided by the CURE trial. Methods: MATCH is a randomized, double-blind, placebo-controlled trial that compares clopidogrel and ASA versus clopidogrel alone in high-risk patients with recently symptomatic cerebrovascular disease. Eligible patients have experienced a transient ischaemic attack (TIA) or IS within the last 3 months and have evidence of at least 1 additional risk factor within the last 3 years (prior IS, MI, stable or unstable angina pectoris, diabetes or symptomatic peripheral arterial disease). Patients were randomized to receive ASA 75 mg once daily or placebo, with both groups receiving clopidogrel 75 mg once daily as part of standard therapy. The primary end point is the composite of IS, MI, vascular death and rehospitalization for an acute ischaemic event. The duration of treatment and follow-up is 18 months for each patient. Results: Enrolment was completed in April 2002, with 7,599 patients randomized to receive the study medication. The mean age at randomization was 66 years, and the qualifying event was IS in 78.9% of patients and TIA in 21.1%. The baseline features of the study cohort indicate a population that is at a high risk for atherothrombotic recurrence. Conclusion: MATCH is a major ongoing trial that will provide important data on the benefit of clopidogrel and ASA compared with clopidogrel alone for reduction of vascular ischaemic events in patients with recent TIA or IS who are at high risk of atherothrombotic event recurrence.

Combination therapy with clopidogrel and aspirin: can the CURE results be extrapolated to cerebrovascula patients?

Several antiplatelet agents with different mechanisms of action are currently available for secondary prevention of ischemic stroke. When used as a single agent, the efficacy of antiplatelet therapy is modest. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; however, it provides only an approximately 15% relative risk reduction for secondary prevention of stroke or other major vascular events.1 Combining 2 antiplatelet agents with different mechanisms of action was demonstrated to provide a substantial increase in efficacy in the ESPS II study.2 In this trial, the relative risk reduction for secondary stroke prevention was 37% with use of a combination of extended-release dipyridamole and aspirin. Importantly, the risk of major bleeding attributable to the combination therapy was no greater than that seen with aspirin alone. Clopidogrel was shown to be a safe and efficacious medication for secondary prevention of vascular events in the CAPRIE study.3 In this trial, the benefit of clopidogrel over aspirin for the prevention of vascular events was a relative risk reduction of 8.7%. In addition, there was less major bleeding in the clopidogrel group, yielding a relative net benefit of about 10%. It has been assumed by many physicians that the combination of clopidogrel with aspirin may be substantially more effective than either agent alone. In fact, many patients with cerebrovascular disease are currently treated with this combination despite the absence of any substantial safety or efficacy data regarding the use of this combination in stroke or transient ischemic attack (TIA) patients. Recently, the results of the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were published.4 This study assessed the safety and efficacy of the combination of clopidogrel and aspirin in patients with acute coronary syndromes without ST-segment elevation. Can the CURE results be extrapolated …

The effect of clopidogrel vs aspirin on recurrent clinical events and total vascular mortality: Results from the CAPRIE study James J. Ferguson, Rollo P. Villareal, Edward K. Massin. Texas Heart Institute, Houston, TX

The effect of clopidogrel vs aspirin on recurrent clinical events and total vascular mortality: Results from the CAPRIE study James J. Ferguson, Rollo P. Villareal, Edward K. Massin. Texas Heart Institute, Houston, TX