| 1. |
- Sacco, R. L., et al.
(författare)
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Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke
- 2008
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Ingår i: New England Journal of Medicine. - Boston : Massachusetts medical society. - 1533-4406 .- 0028-4793. ; 359:12, s. 1238-51
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recurrent stroke is a frequent, disabling event after ischemic stroke. This study compared the efficacy and safety of two antiplatelet regimens--aspirin plus extended-release dipyridamole (ASA-ERDP) versus clopidogrel. METHODS: In this double-blind, 2-by-2 factorial trial, we randomly assigned patients to receive 25 mg of aspirin plus 200 mg of extended-release dipyridamole twice daily or to receive 75 mg of clopidogrel daily. The primary outcome was first recurrence of stroke. The secondary outcome was a composite of stroke, myocardial infarction, or death from vascular causes. Sequential statistical testing of noninferiority (margin of 1.075), followed by superiority testing, was planned. RESULTS: A total of 20,332 patients were followed for a mean of 2.5 years. Recurrent stroke occurred in 916 patients (9.0%) receiving ASA-ERDP and in 898 patients (8.8%) receiving clopidogrel (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11). The secondary outcome occurred in 1333 patients (13.1%) in each group (hazard ratio for ASA-ERDP, 0.99; 95% CI, 0.92 to 1.07). There were more major hemorrhagic events among ASA-ERDP recipients (419 [4.1%]) than among clopidogrel recipients (365 [3.6%]) (hazard ratio, 1.15; 95% CI, 1.00 to 1.32), including intracranial hemorrhage (hazard ratio, 1.42; 95% CI, 1.11 to 1.83). The net risk of recurrent stroke or major hemorrhagic event was similar in the two groups (1194 ASA-ERDP recipients [11.7%], vs. 1156 clopidogrel recipients [11.4%]; hazard ratio, 1.03; 95% CI, 0.95 to 1.11). CONCLUSIONS: The trial did not meet the predefined criteria for noninferiority but showed similar rates of recurrent stroke with ASA-ERDP and with clopidogrel. There is no evidence that either of the two treatments was superior to the other in the prevention of recurrent stroke. (ClinicalTrials.gov number, NCT00153062.)
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| 2. |
- Yusuf, S., et al.
(författare)
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Telmisartan to prevent recurrent stroke and cardiovascular events
- 2008
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Ingår i: New England Journal of Medicine. - : Massachusetts medical society. - 1533-4406 .- 0028-4793. ; 359:12, s. 1225-37
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Prolonged lowering of blood pressure after a stroke reduces the risk of recurrent stroke. In addition, inhibition of the renin-angiotensin system in high-risk patients reduces the rate of subsequent cardiovascular events, including stroke. However, the effect of lowering of blood pressure with a renin-angiotensin system inhibitor soon after a stroke has not been clearly established. We evaluated the effects of therapy with an angiotensin-receptor blocker, telmisartan, initiated early after a stroke. METHODS: In a multicenter trial involving 20,332 patients who recently had an ischemic stroke, we randomly assigned 10,146 to receive telmisartan (80 mg daily) and 10,186 to receive placebo. The primary outcome was recurrent stroke. Secondary outcomes were major cardiovascular events (death from cardiovascular causes, recurrent stroke, myocardial infarction, or new or worsening heart failure) and new-onset diabetes. RESULTS: The median interval from stroke to randomization was 15 days. During a mean follow-up of 2.5 years, the mean blood pressure was 3.8/2.0 mm Hg lower in the telmisartan group than in the placebo group. A total of 880 patients (8.7%) in the telmisartan group and 934 patients (9.2%) in the placebo group had a subsequent stroke (hazard ratio in the telmisartan group, 0.95; 95% confidence interval [CI], 0.86 to 1.04; P=0.23). Major cardiovascular events occurred in 1367 patients (13.5%) in the telmisartan group and 1463 patients (14.4%) in the placebo group (hazard ratio, 0.94; 95% CI, 0.87 to 1.01; P=0.11). New-onset diabetes occurred in 1.7% of the telmisartan group and 2.1% of the placebo group (hazard ratio, 0.82; 95% CI, 0.65 to 1.04; P=0.10). CONCLUSIONS: Therapy with telmisartan initiated soon after an ischemic stroke and continued for 2.5 years did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes. (ClinicalTrials.gov number, NCT00153062.)
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| 3. |
- Reithmaier, Gloria M.S., et al.
(författare)
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Rainfall drives rapid shifts in carbon and nutrient source-sink dynamics of an urbanised, mangrove-fringed estuary
- 2021
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Ingår i: Estuarine, Coastal and Shelf Science. - : Elsevier BV. - 0272-7714. ; 249
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 Elsevier Ltd Estuaries provide valuable ecosystem services, such as carbon storage and nutrient retention, which may be affected by episodic rainfall events. This study aimed to investigate the short-term effect of episodic rainfall on alkalinity, dissolved carbon and nutrient biogeochemistry in a small, urbanised and mangrove-fringed estuary. High temporal resolution sampling (1.5-h interval) at upper and lower estuary sites, as well as groundwater sampling, were conducted over two weeks to assess estuarine source/sink dynamics of total alkalinity (TAlk), organic alkalinity (OAlk), dissolved inorganic carbon (DIC), dissolved organic carbon (DOC), nitrate, nitrite, ammonium and phosphate. Rapid, short-term changes in estuarine biogeochemistry and mixing were triggered by two episodic rainfall events, which delivered 26 mm over 2 h and 39 mm over 21 h. The estuary was a source for TAlk and DIC exporting 2.2 ± 1.9 and 2.2 ± 1.5 mmol/m2 catchment/d, respectively, to the coastal ocean during the observation period. On average, OAlk accounted for 8% of TAlk at the upstream and 3% at the downstream site. Unlike pristine mangrove systems, the estuary was a net sink for DOC, equivalent to ~23% of the DIC source. Rainfall increased catchment nutrient inputs into the estuary, which was a source for ammonium, but a sink for nitrate and nitrite (NOx) throughout the study period. In contrast, phosphate dynamics were less clear. Estuarine biogeochemical transformations affected the exchange with the coastal ocean, driving net TAlk export and by acting as a sink for catchment-derived nutrients. Our high-temporal resolution results suggest that rainfall events rapidly modify estuarine biogeochemistry and mixing, altering the net fluxes of TAlk, dissolved carbon and nutrients to the coastal ocean.
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