Letter regarding article by Markus et al, “dual antiplatelet therapy with clopidogrel and aspirin in symptomatic cardiac stenosis evaluated using doppler embolic signal detection : the clopidogrel and aspirin for reducton of emboli in symptomatic carotid stenosis (CARESS) trial”
Imray, C. (Chris), Higman, Daniel J. and Marshall, Colette (2005) Letter regarding article by Markus et al, “dual antiplatelet therapy with clopidogrel and aspirin in symptomatic cardiac stenosis evaluated using doppler embolic signal detection : the clopidogrel and aspirin for reducton of emboli in symptomatic carotid stenosis (CARESS) trial”. Circulation, Vol.112 (No.20). e325-e326. ISSN 0009-7322Full text not available from this repository.
Official URL: http://dx.doi.org/10.1161/CIRCULATION.AHA.105.560...
We read with interest the report by Markus et al of the CARESS trial,1 in which dual antiplatelet therapy resulted in more effective control of microembolic signals (MESs) than single antiplatelet therapy. There was an associated reduction in the prevalence of transient ischemic attacks (TIAs) and strokes.
Immediately after a TIA or stroke, there is a rise in transcranial Doppler (TCD)-detected MESs. Those patients who continue to experience embolization are at greater risk of another neurological event.2 Markus et al “emphasize the importance of operating urgently in patients wherever possible.” However, a recent systematic review of the risks of carotid endarterectomy in relation to both the clinical indication for and timing of surgery has shown that urgent carotid surgery carries a much higher risk (19.2%, 95% CI 10.7% to 27.8%) than elective surgery (OR 3.9, 95% CI 2.7% to 5.7%; P<0.001; 13 studies).3
|Item Type:||Journal Item|
|Divisions:||Faculty of Medicine > Warwick Medical School > Metabolic and Vascular Health
Faculty of Medicine > Warwick Medical School
|Journal or Publication Title:||Circulation|
|Publisher:||American Heart Association|
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