- Email: [email protected]
IS174 Genetics and stroke — new insights
Invited Speaker Abstracts working together to raise awareness and support surveillance efforts by using their established networks and experience. It is only through the power of partnership that the future of stroke m a n a g e m e n t will be shaped. Constant contact and exchange of experience will improve and facilitate national a n d international actions for improving stroke management. A n outline and discussion of current a n d future possibilities a n d responsibilities will be presented. IS169 Stroke in the developing world vs developing countries Warlow CP. University of Edinburgh, Scotland It is an unfortmtate paradox that, because there are the resources to find out, we know so m u c h more about stroke in the developed world than in the developing world - the poor have always been disadvantaged. A n d yet as developing countries undergo the transition from plagues, pestilence, malnutrition, infections and violent conflict, and as their populations age as a result, they will almost certainly be enveloped in an epidemic of vascular disease, including stroke. At present we know ahnost nothing of stroke in developing countries, other than from biased samples of patients who h a p p e n to be admitted to hospital. At the very least the richer countries should consider funding projects to find out more, while of course continuing to support the prevention of the present scourges of health. Understanding now the early stages of epidemiological and dentographic transition in developing countries might allow their govertmtents to p u t in place strategies to prevent the coming epidemic (but again another paradox is that they cannot afford it unless the strategies are based on the mass prevention approach and n o t the high risk approach). IS 170 Integrated approach to prevention of stroke in low resource settings Dr Shanthi MemUs, Coordinator Cardiovascular DiseasesWorld
Heahh Organization, Geneva, Switzerland Cerebrovascular disease is globally the second leading cause of death, and more than two-thirds of the stroke events occur in low and middle income countries (LMIC). Increasing levels of physical activity, unhealthy diets and to bacco smoking driven by urbanisation and glo balization have increased the prevalence of major cardiovascular risk factors. The risk factor burden in L M I C countries is already substantive. For example out of 4.2% of global D A L Y s attributable to blood pressure 2.8?,'; is from LMIC. With economic growth the risk factor profiles of population in L M I C are anticipated to deteriorate. Curative approaches are resource intensive and offer little hope to the majority of affected individuals who succumb to stroke. Even in settings where sophisticated technology is available 60-65?,'; o f those who suffer strokes either die or are left with permanent disabilities which severely handicap them. Integrated approaches that address cardiovascular risk at population and individual levels are necessary to prevent stroke. Since the Global Strategy for Prevention and control of noncommunicable diseases was endorsed by the World Health Assembly in 2000 the World Health Organization has scaled up efforts to strengthen surveillance, and integrated primary and secondary prevention of stroke in LMIC. In addition other major activities such as, the 2005 global report 'Chronic Diseases: A Vital Investment', the Framework Convention on Tobacco Control and the Global strategy on diet, physical activity and health have been launched to strengthen the response of the global and national health communities to the fast rising epidemic of chronic diseases including stroke. IS 171 Global Stroke Initafive (GSI) & Tile Global Stroke Fund (GSF) Dr. Frank M. Yatsu, Director, GSI. Dept. of Neurology, University of
Texas Medical School at Houston, Houston, Texas, USA
Thursday, November 10, 2005
$29
The global burden of strokes is enormous in accounting for the 2~a leading cause o f death and disability in the world. Annually over 15 million new strokes occur with over 5 million deaths, predominantly in developing countries. Because o f tiffs huge global burden and its known controllable risks, Dr. R u t h Bonita of the W H O provided inspired leadership to develop the GSI in cooperation with the International Stroke Society (ISS) and the World Federation of Neurology 0,VFN). The goals of the GSI are to improve surveillance of stroke risk factors, demographic on stroke subtypes, and prevention and m a n a g e m e n t strategies. To implement these goals, the GSF was established. Pledges and actual deposits into the GSF U S D 300,000.00. Donations so far are: ISS - U S D 137,000.00; W F N - U S D 50,000.00; Kenes - U S D 30,000.00, and U S D 10,000.00 each from the Australian, Japan, & Taiwan Stroke Societies and the European Stroke Conference. Successful initiation o f the stroke initiative has been started in Poland under the direction o f Dr. A n n a Czlonkowska a n d in India under the leadership o f Dr. Prafal Dalal. With the outstanding response thus far for the GSF the future is bright in significantly reducing the global burden of strokes. hfforination on contributing can be obtained from members of the Executive Committee of the ISS: Dr. Julien Bogousslavsky, President; Dr. Takenori Yamaguchi, Vice-President; Dr. Bo Norrving, Secretary; and Dr. F r a n k M. Yatsu, Treasurer and Director, GSI (fi'ank.m. [email protected]). Other contacts are Dr. R u t h Bonita (bonitar@ who.nit); Dr. Shanti Mendis ([email protected]); and Dr. T h o m a s Truelsen ([email protected] 0.
Thursday 10th November 2005 IS173 The paucity of information about stroke incidence and prevalence around the world: does it matter? Ruth Botlita, 1 T h o m a s Truelsen2. 1Chair, STEPS Stroke Surveillance
Coordinating Unit, Switzerland," 2Department of Neurology, Rigshospitalet, Cophenhagen University Hospital, Denmark The present studies of stroke are fragmented surveys, once-off, ad h o g and often outdated. D u e to different methods for collecting stroke data it is difficult to track population changes over time and comparisons between populations is often not possible. Most of our current kitowledge about stroke is from few studies in tffgh-income countries; small and selected u r b a n populations that are unlikely to be represent national stroke rates. According to the Global Burden of Disease study, most stroke events occur in low- a n d middle-income countries from which we have no or only few data; the inverse burden-knowledge relationstfip. The paucity of information about stroke incidence and prevalence rates hampers the support for more resources being allocated to stroke management. Provision o f reliable data on stroke occurrence is essential in the process of increasing awareness of stroke on a global scale. These data represent the comer stone for estimating the impact and target groups for improved primary and secondary prevention, cost-effective interventions, and the need for rehabilitation and care in stroke survivors. Tracking changes over time is important for evaluating various interventions and necessitates that stroke incidence and prevalence studies are implemented and scoped for continuous and consistent data collection. IS174 Genetics and stroke - New insights Bousser, M G . H@ital Lariboisigre, University Paris 7. France
Studies devoted to the genetics of stroke are fraught with difficulties, mainly because of the great phenotypic heterogeneity of stroke and its late age of onset.
$30
Most strokes are polygerdc and confer only a low risk to first degree relatives. Paralleling the clirdcal heterogeneity, there is most likely a huge genetic heterogeneity with a wide spectrunr of low risk alleles involved. Two genes have recently been identified in Iceland respectively encoding for tire phosphodiesterase 4D (PDE4D) and for 5 lipooxygenase activating protein (ALOX5AP) but this important discovery has so far no practical clirdcal implication. By contrast, monogenic varieties of stroke account for a minority of strokes but they confer a high risk to mutation carreers and relatives. Over 50 varieties have been reported, responsible for small artery or large artery diseases, cardiac sources of stroke, prothrombotic disorders, connective tissue diseases, cavernous malformations... Numerous responsible genes have been identified allowing genetic testing and counselling, as well as a better understanding o f the pathophysiology of some varieties o f vascular disorders. Monogenic autosomal dominant varieties of small artery diseases of the brain such as CADASIL and amyloid attgiopathies will be discussed as an example. IS 175 Potential new risk hctors ([or stxoke)
Hankey, GJ. Department of Neurology, Royal Perth Hospital, Perth,
Australia Stroke is heterogeneous, and has different risk factors for different pathological and aetiological subtypes. Two thirds of isehaemie strokes can be attributable to hypertension 26"/0 (195"/o CI: 12-41"/o), snroking 12% (8-16"/o), atrial fibrillation 12"/o (17-17%), ischaemic heart disease 8"/0 (4-12"/o) and diabetes 5"/0 (2-9%); and perhaps another one sixth to increasing blood cholesterol and carotid stenosis. Increasing age, male sex and heredity are other non-modifiable risk factors. The remaining one sixth of ischaemic strokes may be attributable to potential new risk factors but their role is unproven. These include: •
•
• •
•
• • •
Invited Speaker Abstracts
Thursday, November 10, 2005
genetic polymorphisms (e.g. phosphodiesterase 4D, 5-1ipoxygenase activating protein, methylene tetrahydrofolate reductase [MTHFR] C677T, angiotensin-converting enzyme, Factor V Leiden Arg 506 Gin, prothrombin G 20210 A, and apolipoprotein E), inflannnatory markers (C-reactive protein, interleukins [e.g. IL-6, IL-18]), soluble CD 40 ligand, leucocyte count, monocyte count, serum amyloid A), infectious agents (cytomegalovirus, Chlamydia pneumonia, Helieobaete~ pylori, herpes simplex virus, periodontal disease), lipid-related factors (apolipoproteins B and A1, LDL particle size, small dense low density lipoprotein [LDL], lipoprotein (a), oxidised LDL), haemostasis/thrombosis markers (fibrinogen, protein Z, yon Willebrand factor antigen, plasminogen activator inhibitor 1, tissue-type plasminogen activator, factors V, VII and VIII; D-dimer, fibfinopeptide A, prothrombin fragment 1 and 2, atttiplatelet drug resistance), behavioural factors (alcohol, inactivity, poor nutrition, obesity), pyschosocial factors (depression, social isolation, lack of social support), and other factors (homocysteine, microalbuminuria/renal disease, metabolic sytrdrome, obstructive sleep apnoea)
The results of the I N T E R H E A R T study, in which more than 90% of cases of acute myocardial infarction (M 0 were attributable to rdne conventional risk factors, suggests that many potential new risk factors are unlikely to be relevant to the pathogenesis of MI. The same probably applies for atherothromboembolic ischaenric stroke. RandomJsed controlled trials should establish whether reducing the prevalence and level of new risk factors for stroke reduces the incidence of stroke. IS 176 Endarterectomy and Stenting: Where to [tow'.? Brown M M . Institute of Neurology, University College London, UK
Clinical trials have shown that carotid endarterectomy prevents stroke but has significant morbidity. Angioplasty and stenting (curiovascular treatment) for carotid stenosis avoids general anaesthesia, cranial nerve injury and the discomforts of carotid endarterectomy, but many physicians have yet to be persuaded that these teclmJques are safe, durable and effective at preventing stroke. The Carotid and Vertebral Artery Translurrdnal Angioplasty Study (CAVATAS) showed no significant difference in the major risks and benefits of endovascular treatment compared with surgery, but endovascular treatment was associated with more fiequent restenosis than surgery. A systenratic review of all the randomised trials of carotid stenting showed no difference in the major risks o f endovascular treatment compared with surgery, but the confidence intervals were wide and both methods carried a significant risk of stroke at the time of treatment. Pro tection devices have been introduced to improve the safety of carotid stenting, but they have disadvantages and there is still little randomJsed data available about long term outcomes. Further randomJsed trials are therefore required to obtain more data on the risks and long term benefits of carotid stenting in comparison to surgery and establish the optimum method o f treating carotid stenosis. Trials in progress include CREST in N o r t h America, EVA-3S in France, SPACE primarily in Germany, and tire International Carotid Stenting Study (ICSS or CAVATAS-2), which has centres in Europe, N o r t h America and Australia. Updated information on the progress of ICSS is available on the trial website (www.cavatas.com). IS177 Atrial Fibrillation: Old and New Therapies
Hart, R. University of Texas, San Antonio, USA Background: Atrial fibrillation causes disabling cardioembolic stroke,
and antithrombotic agents are efficacious for stroke prevention. Metaanalysis of 24 randomized trials of antithrombotic therapy is presented, as well as data fi'om randomized trials about cardioversion and blood pressure lowering on stroke risk. Methods: Randomized trials identified by using the search strategy of the Cochrane Collaboration Stroke Review Group. Results: Twenty-four trials included 20,018 patients with mean age of 71 years and mean follow-up 1.6 years per patient. Compared to control, stroke was reduced 62% (95% CI, 48% to 72%) by adjusteddose warfarin (6 trials, 2900 participants) and 22% (CI, 6% to 35"/0) by antiplatelet agents (18 trials, 4876 participants). Adjusted-dose warfarin was more efficacious than antiplatelet therapy (relative risk reduction 34?,'o (CI, 157,'o to 49%) (7 trials, 4232 participants). Stroke rates were similar for moderate-risk atrial fibrillation patients given adjusted-dose warfarin (1.8% per year) vs. ximelagatran (1.6% per year), a novel oral anticoagulant (relative risk reduction by ximelagatran 9%; CI, 21% to 31"/o) (13 trials, 7461 participants). Conclusion: Adjusted-dose warfarin and antiplatelet agents reduce stroke in atrial fibrillation patients, and warfarin is more efficacious than aspirin. Ximelagatran is comparable to adjusted-dose warfarin for stroke prevention. The benefit of atttithrombotic therapies to reduce stroke was not substantially offset by major hemorrhage. Judicious use of antithrombotic therapy, tailored according to the individual's estimated stroke risk, importantly reduces stroke in atrial fibrillation patients. Blood pressure lowering reduces vascular events in atrial fibrillation patients with prior stroke/TIA, while cardioversion does not appear to protect against stroke. ISI79 Antiplatelet Strategies Diener HC
Patients with TIA or ischemic stroke carry a risk of recurrent stroke between 5 and 20"/0 per year. In patients with TIA or ischemic stroke of noncardiac origin atttiplatelet drugs are able to decrease the risk of stroke by 11-15"/0 and the risk of stroke, MI and vascular death
Heahh Organization, Geneva, Switzerland Cerebrovascular disease is globally the second leading cause of death, and more than two-thirds of the stroke events occur in low and middle income countries (LMIC). Increasing levels of physical activity, unhealthy diets and to bacco smoking driven by urbanisation and glo balization have increased the prevalence of major cardiovascular risk factors. The risk factor burden in L M I C countries is already substantive. For example out of 4.2% of global D A L Y s attributable to blood pressure 2.8?,'; is from LMIC. With economic growth the risk factor profiles of population in L M I C are anticipated to deteriorate. Curative approaches are resource intensive and offer little hope to the majority of affected individuals who succumb to stroke. Even in settings where sophisticated technology is available 60-65?,'; o f those who suffer strokes either die or are left with permanent disabilities which severely handicap them. Integrated approaches that address cardiovascular risk at population and individual levels are necessary to prevent stroke. Since the Global Strategy for Prevention and control of noncommunicable diseases was endorsed by the World Health Assembly in 2000 the World Health Organization has scaled up efforts to strengthen surveillance, and integrated primary and secondary prevention of stroke in LMIC. In addition other major activities such as, the 2005 global report 'Chronic Diseases: A Vital Investment', the Framework Convention on Tobacco Control and the Global strategy on diet, physical activity and health have been launched to strengthen the response of the global and national health communities to the fast rising epidemic of chronic diseases including stroke. IS 171 Global Stroke Initafive (GSI) & Tile Global Stroke Fund (GSF) Dr. Frank M. Yatsu, Director, GSI. Dept. of Neurology, University of
Texas Medical School at Houston, Houston, Texas, USA
Thursday, November 10, 2005
$29
The global burden of strokes is enormous in accounting for the 2~a leading cause o f death and disability in the world. Annually over 15 million new strokes occur with over 5 million deaths, predominantly in developing countries. Because o f tiffs huge global burden and its known controllable risks, Dr. R u t h Bonita of the W H O provided inspired leadership to develop the GSI in cooperation with the International Stroke Society (ISS) and the World Federation of Neurology 0,VFN). The goals of the GSI are to improve surveillance of stroke risk factors, demographic on stroke subtypes, and prevention and m a n a g e m e n t strategies. To implement these goals, the GSF was established. Pledges and actual deposits into the GSF U S D 300,000.00. Donations so far are: ISS - U S D 137,000.00; W F N - U S D 50,000.00; Kenes - U S D 30,000.00, and U S D 10,000.00 each from the Australian, Japan, & Taiwan Stroke Societies and the European Stroke Conference. Successful initiation o f the stroke initiative has been started in Poland under the direction o f Dr. A n n a Czlonkowska a n d in India under the leadership o f Dr. Prafal Dalal. With the outstanding response thus far for the GSF the future is bright in significantly reducing the global burden of strokes. hfforination on contributing can be obtained from members of the Executive Committee of the ISS: Dr. Julien Bogousslavsky, President; Dr. Takenori Yamaguchi, Vice-President; Dr. Bo Norrving, Secretary; and Dr. F r a n k M. Yatsu, Treasurer and Director, GSI (fi'ank.m. [email protected]). Other contacts are Dr. R u t h Bonita (bonitar@ who.nit); Dr. Shanti Mendis ([email protected]); and Dr. T h o m a s Truelsen ([email protected] 0.
Thursday 10th November 2005 IS173 The paucity of information about stroke incidence and prevalence around the world: does it matter? Ruth Botlita, 1 T h o m a s Truelsen2. 1Chair, STEPS Stroke Surveillance
Coordinating Unit, Switzerland," 2Department of Neurology, Rigshospitalet, Cophenhagen University Hospital, Denmark The present studies of stroke are fragmented surveys, once-off, ad h o g and often outdated. D u e to different methods for collecting stroke data it is difficult to track population changes over time and comparisons between populations is often not possible. Most of our current kitowledge about stroke is from few studies in tffgh-income countries; small and selected u r b a n populations that are unlikely to be represent national stroke rates. According to the Global Burden of Disease study, most stroke events occur in low- a n d middle-income countries from which we have no or only few data; the inverse burden-knowledge relationstfip. The paucity of information about stroke incidence and prevalence rates hampers the support for more resources being allocated to stroke management. Provision o f reliable data on stroke occurrence is essential in the process of increasing awareness of stroke on a global scale. These data represent the comer stone for estimating the impact and target groups for improved primary and secondary prevention, cost-effective interventions, and the need for rehabilitation and care in stroke survivors. Tracking changes over time is important for evaluating various interventions and necessitates that stroke incidence and prevalence studies are implemented and scoped for continuous and consistent data collection. IS174 Genetics and stroke - New insights Bousser, M G . H@ital Lariboisigre, University Paris 7. France
Studies devoted to the genetics of stroke are fraught with difficulties, mainly because of the great phenotypic heterogeneity of stroke and its late age of onset.
$30
Most strokes are polygerdc and confer only a low risk to first degree relatives. Paralleling the clirdcal heterogeneity, there is most likely a huge genetic heterogeneity with a wide spectrunr of low risk alleles involved. Two genes have recently been identified in Iceland respectively encoding for tire phosphodiesterase 4D (PDE4D) and for 5 lipooxygenase activating protein (ALOX5AP) but this important discovery has so far no practical clirdcal implication. By contrast, monogenic varieties of stroke account for a minority of strokes but they confer a high risk to mutation carreers and relatives. Over 50 varieties have been reported, responsible for small artery or large artery diseases, cardiac sources of stroke, prothrombotic disorders, connective tissue diseases, cavernous malformations... Numerous responsible genes have been identified allowing genetic testing and counselling, as well as a better understanding o f the pathophysiology of some varieties o f vascular disorders. Monogenic autosomal dominant varieties of small artery diseases of the brain such as CADASIL and amyloid attgiopathies will be discussed as an example. IS 175 Potential new risk hctors ([or stxoke)
Hankey, GJ. Department of Neurology, Royal Perth Hospital, Perth,
Australia Stroke is heterogeneous, and has different risk factors for different pathological and aetiological subtypes. Two thirds of isehaemie strokes can be attributable to hypertension 26"/0 (195"/o CI: 12-41"/o), snroking 12% (8-16"/o), atrial fibrillation 12"/o (17-17%), ischaemic heart disease 8"/0 (4-12"/o) and diabetes 5"/0 (2-9%); and perhaps another one sixth to increasing blood cholesterol and carotid stenosis. Increasing age, male sex and heredity are other non-modifiable risk factors. The remaining one sixth of ischaemic strokes may be attributable to potential new risk factors but their role is unproven. These include: •
•
• •
•
• • •
Invited Speaker Abstracts
Thursday, November 10, 2005
genetic polymorphisms (e.g. phosphodiesterase 4D, 5-1ipoxygenase activating protein, methylene tetrahydrofolate reductase [MTHFR] C677T, angiotensin-converting enzyme, Factor V Leiden Arg 506 Gin, prothrombin G 20210 A, and apolipoprotein E), inflannnatory markers (C-reactive protein, interleukins [e.g. IL-6, IL-18]), soluble CD 40 ligand, leucocyte count, monocyte count, serum amyloid A), infectious agents (cytomegalovirus, Chlamydia pneumonia, Helieobaete~ pylori, herpes simplex virus, periodontal disease), lipid-related factors (apolipoproteins B and A1, LDL particle size, small dense low density lipoprotein [LDL], lipoprotein (a), oxidised LDL), haemostasis/thrombosis markers (fibrinogen, protein Z, yon Willebrand factor antigen, plasminogen activator inhibitor 1, tissue-type plasminogen activator, factors V, VII and VIII; D-dimer, fibfinopeptide A, prothrombin fragment 1 and 2, atttiplatelet drug resistance), behavioural factors (alcohol, inactivity, poor nutrition, obesity), pyschosocial factors (depression, social isolation, lack of social support), and other factors (homocysteine, microalbuminuria/renal disease, metabolic sytrdrome, obstructive sleep apnoea)
The results of the I N T E R H E A R T study, in which more than 90% of cases of acute myocardial infarction (M 0 were attributable to rdne conventional risk factors, suggests that many potential new risk factors are unlikely to be relevant to the pathogenesis of MI. The same probably applies for atherothromboembolic ischaenric stroke. RandomJsed controlled trials should establish whether reducing the prevalence and level of new risk factors for stroke reduces the incidence of stroke. IS 176 Endarterectomy and Stenting: Where to [tow'.? Brown M M . Institute of Neurology, University College London, UK
Clinical trials have shown that carotid endarterectomy prevents stroke but has significant morbidity. Angioplasty and stenting (curiovascular treatment) for carotid stenosis avoids general anaesthesia, cranial nerve injury and the discomforts of carotid endarterectomy, but many physicians have yet to be persuaded that these teclmJques are safe, durable and effective at preventing stroke. The Carotid and Vertebral Artery Translurrdnal Angioplasty Study (CAVATAS) showed no significant difference in the major risks and benefits of endovascular treatment compared with surgery, but endovascular treatment was associated with more fiequent restenosis than surgery. A systenratic review of all the randomised trials of carotid stenting showed no difference in the major risks o f endovascular treatment compared with surgery, but the confidence intervals were wide and both methods carried a significant risk of stroke at the time of treatment. Pro tection devices have been introduced to improve the safety of carotid stenting, but they have disadvantages and there is still little randomJsed data available about long term outcomes. Further randomJsed trials are therefore required to obtain more data on the risks and long term benefits of carotid stenting in comparison to surgery and establish the optimum method o f treating carotid stenosis. Trials in progress include CREST in N o r t h America, EVA-3S in France, SPACE primarily in Germany, and tire International Carotid Stenting Study (ICSS or CAVATAS-2), which has centres in Europe, N o r t h America and Australia. Updated information on the progress of ICSS is available on the trial website (www.cavatas.com). IS177 Atrial Fibrillation: Old and New Therapies
Hart, R. University of Texas, San Antonio, USA Background: Atrial fibrillation causes disabling cardioembolic stroke,
and antithrombotic agents are efficacious for stroke prevention. Metaanalysis of 24 randomized trials of antithrombotic therapy is presented, as well as data fi'om randomized trials about cardioversion and blood pressure lowering on stroke risk. Methods: Randomized trials identified by using the search strategy of the Cochrane Collaboration Stroke Review Group. Results: Twenty-four trials included 20,018 patients with mean age of 71 years and mean follow-up 1.6 years per patient. Compared to control, stroke was reduced 62% (95% CI, 48% to 72%) by adjusteddose warfarin (6 trials, 2900 participants) and 22% (CI, 6% to 35"/0) by antiplatelet agents (18 trials, 4876 participants). Adjusted-dose warfarin was more efficacious than antiplatelet therapy (relative risk reduction 34?,'o (CI, 157,'o to 49%) (7 trials, 4232 participants). Stroke rates were similar for moderate-risk atrial fibrillation patients given adjusted-dose warfarin (1.8% per year) vs. ximelagatran (1.6% per year), a novel oral anticoagulant (relative risk reduction by ximelagatran 9%; CI, 21% to 31"/o) (13 trials, 7461 participants). Conclusion: Adjusted-dose warfarin and antiplatelet agents reduce stroke in atrial fibrillation patients, and warfarin is more efficacious than aspirin. Ximelagatran is comparable to adjusted-dose warfarin for stroke prevention. The benefit of atttithrombotic therapies to reduce stroke was not substantially offset by major hemorrhage. Judicious use of antithrombotic therapy, tailored according to the individual's estimated stroke risk, importantly reduces stroke in atrial fibrillation patients. Blood pressure lowering reduces vascular events in atrial fibrillation patients with prior stroke/TIA, while cardioversion does not appear to protect against stroke. ISI79 Antiplatelet Strategies Diener HC
Patients with TIA or ischemic stroke carry a risk of recurrent stroke between 5 and 20"/0 per year. In patients with TIA or ischemic stroke of noncardiac origin atttiplatelet drugs are able to decrease the risk of stroke by 11-15"/0 and the risk of stroke, MI and vascular death