Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial
The Lancet NeurologyPublished 1 November 2007
James Kennedy, Michael D. Hill, Karla J. Ryckborst, Michael Eliasziw, Andrew M. Demchuk, Alastair M. Buchan
Citations558
SJR quartileQ1
SJR score11.73
SNIP13.75
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
Abstract
Immediately after TIA or minor stroke, patients are at high risk of stroke, which might be reduced by using clopidogrel in addition to aspirin. The haemorrhagic risks of the combination of aspirin and clopidogrel do not seem to offset this potential benefit. We were unable to provide evidence of benefit of simvastatin in this setting. This aggressive prevention approach merits further study.
Keywords
Medicine
StrokeClassification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.
12,286 Citations1993Harold P. Adams, Birgitte H. Bendixen +5 more
The TOAST stroke subtype classification system is easy to use and has good interobserver agreement and should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke.
New England Journal of MedicineTissue Plasminogen Activator for Acute Ischemic Stroke
11,541 Citations1995The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group
The LancetMRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial
6,967 Citations2002S. Féasson
Adding simvastatin to existing treatments safely produces substantial additional benefits for a wide range of high-risk patients, irrespective of their initial cholesterol concentrations.
The LancetA randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE)
6,453 Citations1996
Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death.
CirculationACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations
4,509 Citations2000Eugene Braunwald, Elliott M. Antman +22 more
New England Journal of MedicineHigh-Dose Atorvastatin after Stroke or Transient Ischemic Attack
2,887 Citations2006The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators
In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke.
New England Journal of MedicineClopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events
2,827 Citations2006Deepak L. Bhatt, Keith A.A. Fox +24 more
Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes.
The LancetA randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee
2,732 Citations1996Martin Dennis
JAMAEffects of Atorvastatin on Early Recurrent Ischemic Events in Acute Coronary Syndromes<SUBTITLE>The MIRACL Study: A Randomized Controlled Trial</SUBTITLE>
2,493 Citations2001Gregory G. Schwartz
Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes and the MIRACL study are studied.
The LancetAspirin 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
2,273 Citations2004Hans‐Christoph Diener, Julien Bogousslavsky +7 more
Adding aspirin to clopidogrel in high-risk patients with recent ischaemic stroke or transient ischaemia 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.
The LancetThe International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke
1,890 Citations1997Peter Sandercock
Aspirinallocated patients had significantly fewer recurrent ischaemic strokes within 14 days with no significant excess of haemorrhagic strokes, so the reduction in death or non-fatal recurrent stroke with aspirin was significant.
JAMAShort-term Prognosis After Emergency Department Diagnosis of TIA
1,291 Citations2000S. Claiborne Johnston
The results indicate that the short-term risk of stroke and other adverse events among patients who present to an ED with a TIA is substantial and characteristics of the patient and the TIA may be useful for identifying patients who may benefit from expeditious evaluation and treatment.
The LancetCAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke
1,222 Citations1997Christopher Chen
Taken together, CAST and the similarly large IST show reliably that aspirin started early in hospital produces a small but definite net benefit, with about 9 (SD 3) fewer deaths or non-fatal strokes per 1000 in the first few weeks, and with 13 (5) fewer dead or dependent per 1000 after some weeks or months of follow-up.
The LancetEffect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison
1,187 Citations2007Peter M. Rothwell, Matthew F. Giles +14 more
Early initiation of existing treatments after TIA or minor stroke was associated with an 80% reduction in the risk of early recurrent stroke, and early treatment did not increase therisk of intracerebral haemorrhage or other bleeding.
The LancetAspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial
999 Citations2006‡
The ESPRIT results, combined with the results of previous trials, provide sufficient evidence to prefer the combination regimen of aspirin plus dipyridamole over aspirin alone as antithrombotic therapy after cerebral ischaemia of arterial origin.
BMJPopulation based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services
766 Citations2004A J Coull, Joanna Lovett +1 more
The early risks of stroke after a TIA or minor stroke are much higher than commonly quoted and more research is needed to determine whether these risks can be reduced by more rapid instigation of preventive treatment.
CirculationDual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection
748 Citations2005Hugh S. Markus, Dirk W. Droste +5 more
In patients with recently symptomatic carotid stenosis, combination therapy with clopidogrel and aspirin is more effective than aspirin alone in reducing asymptomatic embolization.
Thrombosis and HaemostasisIdentification and Biological Activity of the Active Metabolite of Clopidogrel
748 Citations2000Pierre Savi, Jean‐Marie Pereillo +6 more
This study demonstrates that an active metabolite can be generated from human liver microsomes incubated with clopidogrel, and its structure is identified using several analytical methodologies.
NeurologyEarly risk of recurrence by subtype of ischemic stroke in population-based incidence studies
746 Citations2004Joanna Lovett, Andrew Coull +1 more
The risk of early recurrent stroke is highest in patients with large-artery atherosclerosis (LAA), which supports the need for urgent carotid imaging and prompt endarterectomy.
NeurologyWhy are stroke patients excluded from TPA therapy?
708 Citations2001P A Barber, Joyce L. Zhang +3 more
The majority of patients are unable to receive TPA for acute ischemic stroke because they do no not reach the hospital soon enough and a third of these patients were left either dependent or dead, bringing into question the initial decision not to treat.
CirculationAtorvastatin Reduces the Ability of Clopidogrel to Inhibit Platelet Aggregation
687 Citations2003Wei C. Lau, Lucy Waskell +8 more
CYP3A4 activates clopidogrel and atorvastatin competitively inhibits this activation and use of a statin not metabolized by Cytochrome P450 (CYP) 3A4 and point-of-care platelet function testing may be warranted in patients treated with clopIDogrel.
The Lancet NeurologyA transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects
666 Citations2007Philippa C. Lavallée, Elena Meseguer +15 more
Use of TIA clinics with 24-h access and immediate initiation of preventive treatment might greatly reduce length of hospital stay and risk of stroke compared with expected risk.
StrokeIndications for Early Aspirin Use in Acute Ischemic Stroke
603 Citations2000ZhengMing Chen, Peter Sandercock +7 more
Early aspirin is of benefit for a wide range of patients, and its prompt use should be routinely considered for all patients with suspected acute ischemic stroke, mainly to reduce the risk of early recurrence.
Drug Metabolism and DispositionThe Metabolism of Clopidogrel Is Catalyzed by Human Cytochrome P450 3A and Is Inhibited by Atorvastatin
374 Citations2003Thomas A. Clarke, Lucy Waskell
CYP3A4 and 3A5 metabolize clopidogrel faster than other human p450 isozymes and are the most abundant p450s in human liver, so they are predicted to be predominantly responsible for the activation of clopIDogrel in vivo.
StrokeVery Early Risk of Stroke After a First Transient Ischemic Attack
368 Citations2003Joanna Lovett, Martin Dennis +4 more
The early risk of stroke from date of first-ever TIA is likely to be higher than commonly quoted and public education about the symptoms of Tia is needed so that medical attention is sought more urgently and stroke prevention strategies are implemented sooner.
NeurologyThe high risk of stroke immediately after transient ischemic attack
363 Citations2004Michael D. Hill, Nikolaos Yiannakoulias +4 more
Although stroke is common after TIA, the early risk is not predicted by clinical and demographic factors, andidated models to identify which patients require urgent intervention are needed.
JAMAAnalysis and Reporting of Factorial Trials
284 Citations2003Finlay A. McAlister, Sharon E. Straus +2 more
The findings suggest that investigators are appropriately restricting their use of the factorial design to those situations in which 2 (or more) treatments do not have the potential for substantive interaction.
CirculationLack of Adverse Clopidogrel–Atorvastatin Clinical Interaction From Secondary Analysis of a Randomized, Placebo-Controlled Clopidogrel Trial
267 Citations2003Jacqueline Saw, Steven R. Steinhubl +5 more
Although ex vivo testing has suggested a potential negative interaction when coadministering a CYP3A4-metabolized statin with clopidogrel, this was not clinically observed statistically in a post hoc analysis of a placebo-controlled study.
Canadian Medical Association JournalEarly risk of stroke after a transient ischemic attack in patients with internal carotid artery disease
244 Citations2004Michael Eliasziw
Patients who had a hemispheric TIA related to internal carotid artery disease had a high risk of stroke in the first few days after the TIA, and patients with more severe stenosis appeared to be at no greaterrisk of stroke than patients with lesser degrees of stenosis.
Pharmacology & TherapeuticsMetabolism and Drug Interactions of 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors in Transplant Patients
219 Citations1998Uwe Christians, Wolfgang Jacobsen +1 more
In the treatment of transplant patients, from a drug interaction perspective, pravastatin, which is not significantly metabolized by CYP enzymes, and fluvastatin compare favorably with the other statins for which the major metabolic pathways are catalyzed by CyP3A.
Journal of Cerebral Blood Flow & MetabolismStatins and Stroke
199 Citations2005Matthias Endres
Retrospective clinical evidence suggests that long-term statin administration may not only reduce stroke risk but also improve outcome and early secondary prevention trials are underway to test the hypothesis that statin treatment initiated immediately after an event improves short-term outcome.
European Heart JournalLipophilic statins interfere with the inhibitory effects of clopidogrel on platelet function — a flow cytometry study
198 Citations2003H. Neubauer
Certain statins which are substrates of the CYP3A4 isoform competitively inhibit the metabolic activation of clopidogrel, and there is a relative clopIDogrel effect of more than 80% in the maintenance phase.
CirculationEffects of Atorvastatin on Stroke in Patients With Unstable Angina or Non-Q-Wave Myocardial Infarction
192 Citations2002David D. Waters, Gregory G. Schwartz +8 more
Intensive cholesterol lowering with atorvastatin over 16 weeks in patients with acute coronary syndromes reduced the overall stroke rate by half and did not cause hemorrhagic stroke.
Cerebrovascular DiseasesRationale, Design and Baseline Data of a Randomized, Double-Blind, Controlled Trial Comparing Two Antithrombotic Regimens (a Fixed-Dose Combination of Extended-Release Dipyridamole plus ASA with Clopidogrel) and Telmisartan versus Placebo in Patients with Strokes: The Prevention Regimen for Effectively Avoiding Second Strokes Trial (PRoFESS)
170 Citations2007Hans‐Christoph Diener, Ralph L. Sacco +1 more
Journal of the American College of CardiologyLack of Evidence of a Clopidogrel–Statin Interaction in the CHARISMA Trial
169 Citations2007Jacqueline Saw, Danielle M. Brennan +5 more
JAMAEffects of Early Treatment With Statins on Short-term Clinical Outcomes in Acute Coronary Syndromes
166 Citations2006Matthias Briel, Gregory G. Schwartz +14 more
Based on available evidence, initiation of statin therapy within 14 days following onset of ACS does not reduce death, MI, or stroke up to 4 months.
Canadian Medical Association JournalManagement and outcomes of transient ischemic attacks in Ontario
163 Citations2004David J. Gladstone
Patients in whom TIA is diagnosed in the emergency department have high immediate and short-term risks of stroke, however, their condition is underinvestigated and undertreated compared with stroke: many do not receive the minimum recommended diagnostic tests within 30 days.
StrokeVascular Effects of Statins in Stroke
152 Citations1997Norman Delanty, Carl J. Vaughan
Hypercholesterolemia has reemerged as a risk factor for ischemic stroke and statin therapy in patients with cerebrovascular disease through multiple beneficial effects within the vascular milieu is protected.
StrokeVerifying the Stroke-Free Phenotype by Structured Telephone Interview
145 Citations2000James F. Meschia, Thomas G. Brott +7 more
A structured telephone interview can identify the stroke-free individual with a high degree of confidence in a very efficient manner and may be particularly suited for centralized verification of stroke discordancy in multicentered sib-pair genetic studies.
StrokeAre Patients With Acutely Recovered Cerebral Ischemia More Unstable?
66 Citations2003S. Claiborne Johnston, J. Donald Easton
Patients with TIA may be a greater risk of subsequent neurological deterioration from causes other than hemorrhage, and substantial acute recovery may be an indicator of greater instability more broadly.
Annals of NeurologyEarly recovery after cerebral ischemia risk of subsequent neurological deterioration
60 Citations2003S. Claiborne Johnston, Enrique C. Leira +2 more
Among patients with acute cerebral ischemia, those who recover substantially within 24 hours may be at greater risk of subsequent neurological deterioration due to causes other than hemorrhage, and substantial acute recovery remained an independent predictor of subsequent deterioration.
PubMedDid the major clinical trials of statins affect prescribing behaviour?
32 Citations2001Muhammad Mamdani, Jack V. Tu
Randomized controlled trials (RCTs) have clearly demonstrated that cholesterol-lowering statins are beneficial in the treatment and prevention of coronary heart disease.