salicylates and Cerebral-Hemorrhage

The antiplatelet effect of clopidogrel is reportedly influenced by cytochrome P450 2C19 (CYP2C19) polymorphisms. However, there is no data concerning the relationship between stroke recurrence and CYP2C19 polymorphisms in patients treated with clopidogrel for secondary prevention of ischemic stroke. Triflusal may be an alternative therapy for clopidogrel in patients with poor genotype. The Comparison of Triflusal and Clopidogrel Effects in Secondary Prevention of Stroke Based on Cytochrome P450 2C19 Genotyping (MAESTRO) study will investigate the effect of antiplatelet agents based on CYP2C19 polymorphisms in secondary prevention of ischemic stroke.. Assuming that 55% of patients belong to the poor genotype group, the required sample size is 1080 patients with at least 24 months of follow-up. This study is designed as a prospective, multicenter, randomized, parallel-group, open-label, and blind genotype trial. Patients who experience their first non-cardiogenic ischemic stroke within 30 days prior to screening are eligible. Patients received 300 mg triflusal twice a day or 75 mg clopidogrel once daily during the trial. The study is registered with ClinicalTrials.gov (NCT01174693).. The primary outcome is recurrent ischemic stroke or hemorrhagic stroke. Secondary outcomes consist of composite major vascular events including stroke, myocardial infarction, coronary revascularization, or vascular death.. Personalized medicine may be essential for patients according to individual drug metabolism abilities. MAESTRO is the first prospective study designed to evaluate the effect of CYP2C19 polymorphism in secondary stroke prevention and will resolve several questions regarding preventive antiplatelet agents for recurrent stroke.

Topics: Brain Ischemia; Cerebral Hemorrhage; Chemoprevention; Clopidogrel; Cytochrome P-450 CYP2C19; Follow-Up Studies; Genotype; Humans; Pharmacogenomic Variants; Platelet Aggregation Inhibitors; Recurrence; Salicylates; Secondary Prevention; Single-Blind Method; Stroke; Ticlopidine; Treatment Outcome

The place of platelet antiaggregants in the aetiology of intracerebral hemorrhage (IH) has not been extensively studied.. To analyze the characteristics of IH in patients treated with platelet antiaggregants and the possible clinical and prognostic differences from other primary IH.. A retrospective study of patients admitted to hospital with primary IH from 1985 to 1997. The cases were IH patients while being treated with platelet antiaggregants. For each case we selected two controls with IH and similar age and IH risk factors. The following data was analyzed: start of clinical condition; type, dose, indication and duration of treatment with antiaggregants; mortality, localization, volume and extension of IH to the ventricles. The last four variables were compared with the control group using the ji squared test (chi 2) and the t student test.. 21one patients had a primary IH while being treated with antiaggregants: 20 with salicylates (17 aspirin and 3 riflusal) and one with ticlopidine. The dose of aspirin was 500 mg or less in 90% of the cases. In the group treated with salicylates, this was given for more than 20 months in 90% of the cases. Initially there was no clinical progression in any case. No significant differences were observed between the variable compared, although there was a tendency to greater volume, extension to the ventricles and mortality in the group treated with antiaggregants.. More studies with larger numbers of patients are necessary to be able to confirm the tendencies observed.

Topics: Aged; Aged, 80 and over; Aspirin; Cerebral Hemorrhage; Female; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Prognosis; Retrospective Studies; Risk Factors; Salicylates

Topics: Brain Ischemia; Cerebral Hemorrhage; Female; Humans; Male; Platelet Aggregation Inhibitors; Salicylates

The course of 177 consecutive patients with severe salicylate self-poisoning treated in an intensive care unit (ICU) during a period of 15 years is presented. On admission, cerebral depression was observed in 61% respiratory failure was present in 47%, acidosis in 36% and cardiovascular function was impaired in 14%. A mortality rate of 15% was observed, which was proportionally higher in patients more than 40 years old and in patients with delayed diagnosis. Twenty-seven patients died and an autopsy was performed on 26 patients. The main autopsy diagnosis was ulcers of the gastrointestinal tract in 46%, pulmonary oedema in 46%, cerebral oedema in 31% and cerebral haemorrhage in 23%.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Brain Edema; Cerebral Hemorrhage; Child; Child, Preschool; Duodenal Ulcer; Female; Humans; Infant; Intensive Care Units; Male; Middle Aged; Pulmonary Edema; Respiratory Distress Syndrome; Retrospective Studies; Salicylates; Salicylic Acid; Stomach Ulcer; Suicide, Attempted

Topics: Cerebral Hemorrhage; Glucocorticoids; Humans; Meninges; Salicylates

Topics: Adult; Anticoagulants; Cerebellum; Cerebral Hemorrhage; Drug Synergism; Female; Humans; Salicylates