Accès ouvert déclaré
2017
article
Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial
Philip M. Bath, Lisa J Woodhouse, Jason P. Appleton, Maia Beridze, Hanne Christensen, Robert A. Dineen, Lelia Duley, Timothy J. England, Katie Flaherty, Diane Havard, Stan Heptinstall, Marilyn James, Kailash Krishnan, Hugh S. Markus, Alan Montgomery, Stuart Pocock, Marc Randall, Annemarei Ranta, Thompson Robinson, Polly Scutt, G.S. Venables, Nikola Sprigg, Louisa Christensen, Line Bentsen, Christine Krarup Hansen, TL Thomsen, Christina Kruuse, Helene H. Jensen, Sirje Hansen, Vladimír Petrovič, N Beridze, N. M. Kakabadze, Tinatin Kherkheulidze, D D Kakabadze, I Toidze, N. Lobjanidze, N. Akiashvili, A Tevdoradze, N Khizanishvili, T Tsanava, Rebecca J. Taylor, I. Iniesta, J Kok, J. P. Duignan, Michael Funnell, Pietro Cariga, M Rodriguez, I J Watson, Scott Tennant, Malcolm Macleod, Jacqueline Furnace, Heather Gow, Janice Irvine, Anu Joyson, Sandra Nelson, Vicky Taylor, Matthew Smith, Ruth Bellfield, Brigid Hairsine, Ruth Davies, Ashlee Dodd, John Corrigan, Mandy Doherty, Abdullah Ahmed, Carol Denniss, S Johnson-Holland, Kenny Kay, Rosasco Palau, Grace Auld, P Daboo, Renuka Erande, Gemma Grimwood, Dionne Hove, Laura Howaniec, Ozlem Redjep, R Rangasamay, Georgina Butt, David Sandler, Julie Reddan, Samantha Stafford, James McIlmoyle, Stuart Maguire, P. Murphy, John Chambers, Lucy Belle Guthrie, Mairead Osborn, M Burn, Aienne Benford, Amulya Misra, Derek Hilton, Elizabeth O’Brien, Elaine Amis, Stephen Finlay, Jenny Mitchell, Olivia Geraghty, Kirsten Harvey, Bath Hazel, Sheila Mashate, Peter Wilding, Mahmud Sajid, Mark W. Ball, Rachel Gascoyne, Alison C. Wright, Kausik Chatterjee, Stephen Booth, Helen Eccleson, Ciaran Kelly, S Leason, Charlotte Perkins, David Bruce, Ellen Brown, Susan Clayton, Mark Garside, Gill Rogers, Enas Lawrence, Syed Mahmood, C Watchurst, Dinesh Chadha, Loren E. Glover, L Holford, Kyle Smith, Deborah Walstow, Rhys Williams, L. O’Shea, J Goodsell, C. Athulathmudali, E Barbon, Robert Namushi, P.C. Jacob, Linda Johnson, Deborah Morse, Caroline McGhee, Ottilia Speirs, S Atkinson, Alice Peacocke, Peter Langhorne, Ruth Graham, Fiona Wright, Christine McAlpine, A Ravindrane, M Bajoriene, L Matter, S Windebank, Elio Giallombardo, Deborah Dellafera, Charlotte Eglinton, Jill Wilson, David Broughton, Kath Chapman, Lynn Dixon, M Zaidi, K. Ayes, J Kessell, Dulka Manawadu, O Adegbaju, J Aeron‐Thomas, Kevin Anderson, Amberly Brigden, E. Cattermole, J Good, Syed Adeel Hassan, E Khoromana, L Lee-Carbon, Kimberly Marks, Emma McKenzie, Nyma Sikondari, Martin Cooper, K Whysall, Inez Wynter, John Bamford, Ameer E Hassan, Peter Wanklyn, Mary Kambafwile, Linetty Makawa, Dean Waugh, Emelda Veraque, MGG Soliman, Sally A. Arif, Roger Brown, S Butler, Claire Hewitt, Julia Hindle, Aparna Pusalkar, Hannah Beadle, Karissa Chan, M Siddiqui, Puneet Dangri, Sai Sandeep Buddha, Asaipillai Asokanathan, Amit Mistri, D. Eveson, Kashif Musarrat, Lisa Manning, Sonia S. Anand, P. Christian, Sher Bahadar Khan, Chirag B. Patel, Moe Sein, J Banns, Elspeth Gibson, Teresa R Gordon, Y Gruenbeck, Siu‐Yin Wong, Prabal Datta, Gavin Bateman, Louise Jackson, Ann Needle, Y. Duodu, Richard Oliver, C. Padilla-Harris, Mark Barber, Derek Esson, Fiona Brodie, Caroline McInnes, K. Fotherby, Donna Butler, Deborah Morgan, Kevin Preece, Angela Willberry, M Dent, Fiona Hammonds, John W. Hunt, C R Vernon, Dermot O’Kane, F Faola, P H Lai, J O'Callaghan, Craig J. Smith, Christopher Price, Rachel Lakey, V.E. Riddell, Adam R. Smith, G Storey, Sunil Munshi, Amanda Buck, Judith Clarke, Nicola Gilzeane, Maureen Godfrey, Rekha Keshvara, Carla Richardson, Jack Roffe, Lisa Ryan, Faye Shelton, W Sunman, A Tittle, J. Tomlinson, Katherine Whittamore, Gwendoline Wilkes, Peter Owusu‐Agyei, Nigel Temple, David Mangion, Anya G. Hardwick, Kimberley Netherton, Azlisham Mohd Nor, Benjamin Hyams, S. Norman, Nicola Persad, Suzanne Ragab, Christine Dickson, Judith Dube, E. M. Jinks, Kerstin Knops, Beverley Wadams, Khalid Ali, Jane Gaylard, Geoffrey Spurling, L. Sztriha, T. Ajao, Moses O. Alao, Francis K.L. Chan, Paula Webster, Patricia Howard, Tracey Dobson, Lisa Hyatt, Don Sims, Jonathan W. Cunningham, Bernard Esisi, Tim Cassidy, Masooma Zainab Bokhari, Beverley McClelland, Betty Mokoena, G Gunathilagan, Sophie Jones, M Reader, George Thomas, S Tilby, Paul Findlay, Fred F. Barrett, F.M. Leslie, Sarah J. Ross, Ian Shread, James Okwera, Jo Howe, Frances Harrington, Gillian Courtauld, Christine Schofield, Richard Donnelly, Mohana Maddula, Jon Scott, J. Beavan, K. Muhidden, Iqra Ishaque Memon, Megan M. Clarke, Amanda Hedstrom, Lisa Mills, Anthony Hemsley, A Bowring, Lucy Boxall, Hayley Kingwell, Samantha Keenan, Caroline Roughan, A Manoj, Patrick Cox, Glyn Fletcher, P Lopez, Hedley Emsley, Bindu Gregary, Alison McLoughlin, Sahil Raj, Christine Roffe, Nenette Abano, Adrian Barry, Adrian Butler, Racquel Carpio, Kamila Castro, K. Finney, SA Gomm, Joanne Hiden, Jeanette Grocott, Sue Lyjko, Holly Maguire, Alda Remegoso, R. Sanyal, Stephanie Stevens, Indira Natarajan, J Chembala, Girish Muddegowda, Anushka Warusevitane, A Blight, Olga Balazikova, Craig Lawlor, Louise Shaw, Denise Button, Deborah Howcroft, Suzanne Lucas, B. Madigan, Stephanie McCann, A. Dixit, Amina Barkat, Joseph A. Davis, M Fawcett, Lisa D. Finlay, Helen Guy, Chelsea C. Hays, Valerie Hogg, Elizabeth Horsley, C Hubbuck, Charlene Pringle, C Stevenson, Kelley Storey, Teresa Thompson, Stephen Woodward, Avantika Banerjee, C Allcock, S Merotra, Chris Douglass, E Campbell, R. Jarapa, Mary Johnes, C Keaveney, Tracy Marsden, Zayar Naing, J. R. Pérez, Krista M Shaw, Toby Black, Alpha Anthony, Caroline S. Clarke, J. Michael Paterson, Kevin Deighton, C Blank, Cara Doyle, Suzanna Duty, Kristina Gill, K. Harkness, CDR I Kamara, Emma Richards, Khaled Elfandi, Paul Guyler, Paula Harman, C Khuoge, Swapna Kunhunny, Sharon Tysoe, Barry Moynihan, Temi Adedoyin, Neha Chopra, N Dayal, Rita Ghatala, Naomi Jeyaraj, I. Jones, Fiona Kennedy, Lourda Kerin, Nyma Khanom, Steff Lewis, S Maheswaran, L Montague, M Niemierko, John O’Reilly, Sarah Trippier, Fran Watson, Paul Wilkinson, Elizabeth V. Young, K Dizayee, Helen Cochrane, J.R O’Connell, L Mokoena, E Osborne, Anil K. Nair, Jill Greig, Colin Jenkins, James D. Powell, Fiona Price, Mohammed M. Chowdhury, S Brixey, Lorraine Hunt, N Rands, Gregory C. Rose, S Stoddart, Manivannan Srinivasan, N Motherwell, Raj Shekhar, T Fuller, A.C. Lankester, P Lingwood, Conor S. Rankin, Hueldine Webb, Becky Jupp, Jo Bell, Gail Hann, Barbara Longland, Catherine Ovington, Biju Bhaskaran, Georgina Ayres, C. Cabell Bailey, Helen Bearne, Jean Buxton, Pauline Fitzell, Christian Hilaire, Deborah F. Kelly, Sebastian Szabo, Dawn Tomlin, Ed Gamble, B Charles, Raymond Kumar, Tanya Fluskey, Zoe Mellor, Janny G.P. Peters, Victoria Sutton, Anthony Kenton, Sheila Nyabadza, Sandip Ghosh, Maria Aparecida Coelho de Arruda Henry, Balakrishna Kumar, C Ambulo, Susan E. Crawford, Tarn Nozedar, M Platton, Vera Cvoro, Mandy Couser, K McCormick, David Wilkinson, M K Javaid, S Hurdowar, T Attygalle, Saul Sundayi, Olu Orugun, Helen Crowther, R Jolly, Una Poultney, A Azim, Milena Krasinska-Chavez, James R. White, N Sengupta, Jordi Margalef, Maria Metiu, S Meenakshisundaram, Sharon Dealing, David Hargroves, Eva Beranová, Luke Cowie, Hannah Rudenko, Audrey Thomson, Anna Verrion, Khalid Rashed, C Buckley, David Hayward, Kathryn L. Jenkins, Elizabeth G. Keeling, R Rowland-Axe, Carinna Vickers, Diane P. Wood, Amy Lehman, Martyn Patel, Heather Russell, Hafeez Ur Rehman Siddiqui, Daniel L. Forrest, Pamela Farren
184Citations signalées — pas une note de qualité
15Institutions déclarées
3Pays d’affiliation déclarés
Résumé fourni par la source
BACKGROUND: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplatelet therapy (combined aspirin, clopidogrel, and dipyridamole) with that of guideline-based antiplatelet therapy. METHODS: We did an international, prospective, randomised, open-label, blinded-endpoint trial in adult participants with ischaemic stroke or transient ischaemic attack (TIA) within 48 h of onset. Participants were assigned in a 1:1 ratio using computer randomisation to receive loading doses and then 30 days of intensive antiplatelet therapy (combined aspirin 75 mg, clopidogrel 75 mg, and dipyridamole 200 mg twice daily) or guideline-based therapy (comprising either clopidogrel alone or combined aspirin and dipyridamole). Randomisation was stratified by country and index event, and minimised with prognostic baseline factors, medication use, time to randomisation, stroke-related factors, and thrombolysis. The ordinal primary outcome was the combined incidence and severity of any recurrent stroke (ischaemic or haemorrhagic; assessed using the modified Rankin Scale) or TIA within 90 days, as assessed by central telephone follow-up with masking to treatment assignment, and analysed by intention to treat. This trial is registered with the ISRCTN registry, number ISRCTN47823388. FINDINGS: 3096 participants (1556 in the intensive antiplatelet therapy group, 1540 in the guideline antiplatelet therapy group) were recruited from 106 hospitals in four countries between April 7, 2009, and March 18, 2016. The trial was stopped early on the recommendation of the data monitoring committee. The incidence and severity of recurrent stroke or TIA did not differ between intensive and guideline therapy (93 [6%] participants vs 105 [7%]; adjusted common odds ratio [cOR] 0·90, 95% CI 0·67-1·20, p=0·47). By contrast, intensive antiplatelet therapy was associated with more, and more severe, bleeding (adjusted cOR 2·54, 95% CI 2·05-3·16, p<0·0001). INTERPRETATION: Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice. FUNDING: National Institutes of Health Research Health Technology Assessment Programme, British Heart Foundation.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial
- Date Crossref
- 01/03/2018
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude et ne compte pas comme une seconde source scientifique indépendante.
Institutions déclarées
Une affiliation ne permet pas de déduire la nationalité d’un auteur.
Sujets associés
Antiplatelet Therapy and Cardiovascular DiseasesAcute Ischemic Stroke ManagementIntracerebral and Subarachnoid Hemorrhage Research