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 0009-7322

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Abstract

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
ISSN:	0009-7322
Date:	2005
Volume:	Vol.112
Number:	No.20
Page Range:	e325-e326
Identification Number:	10.1161/CIRCULATION.AHA.105.560755
Status:	Peer Reviewed
Publication Status:	Published
Related URLs:	Publisher
URI:	http://wrap.warwick.ac.uk/id/eprint/52181

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