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Patients with symptoms of arterial disease have a high risk of getting a (possibly fatal) stroke or heart attack (myocardial infarction). Antiplatelet therapy with drugs like aspirin prevents blood clotting and reduces the risk of strokes, heart attacks, and death from vascular disease. Dipyridamole, another antiplatelet drug, given on its own or together with aspirin might reduce the risk even further. This review included 29 studies involving 23019 participants. When we compared the effects of dipyridamole (alone or together with aspirin) with aspirin alone there was no evidence of an effect on death from vascular causes. When we compared the effects on the occurrence of vascular events (strokes, heart attacks, and deaths from vascular diseases) the combination of aspirin and dipyridamole had an advantage over aspirin alone. This result holds particularly true for patients with ischaemic stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

We wanted to compare the safety and effectiveness of oral antiplatelet therapy versus placebo or no treatment in people with acute ischaemic stroke to see if oral antiplatelet drugs reduced the number of deaths and improved the long‐term outcomes in survivors.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

After heart valve replacement oral anticoagulation (a blood thinner) is frequently used to keep blood clots from forming on the valve. These blood clots can block the flow of blood through the valve or break off and cause a stroke. Blood thinners, such as coumadin, reduce the risk of these outcomes and require careful monitoring. Drugs that affect the platelets, such as aspirin, are not effective alone but may add benefit to the blood thinners. This updated review of 13 trials found that oral anticoagulation and antiplatelet drugs were more effective than anticoagulation alone. The addition of antiplatelet drugs to anticoagulants increases the risk of bleeding by about 50%. Low‐dose aspirin (less than 100 mg daily) may be associated with the lowest risk of bleeding. However, in general the quality of the included trials tended to be low, possibly reflecting the era when the majority of the trials were conducted (1970s and 1980s when trial methodology was less advanced).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pregnancy complications such as pre‐eclampsia and eclampsia, intrauterine fetal growth restriction and placental abruption are thought to be related to abnormalities in the development and function of the placenta. Treatment with heparin to prevent the development of blood clots within the placenta appears to be a promising intervention to prevent these complications. The numbers of pregnant women with pre‐eclampsia, preterm birth, perinatal death and a low birthweight infant (weighing less than the 10th centile for gestational age) were reduced with this treatment. Ten randomised trials involving 1139 women met the inclusion criteria for the review. Nine studies compared heparin (alone or in combination with dipyridamole) with no treatment; and one compared triazolopyrimidine with placebo. The most commonly recognised side effect for women related to this treatment was mild skin bruising. To date, important information about serious adverse infant and long‐term childhood outcomes with using anti‐clotting medications is unavailable. Further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Patients with type 2 diabetes have a much higher risk of strokes and heart attacks than the general population. Most strokes and heart attacks are caused by blood clots. Adenosine‐diphosphate (ADP) receptor antagonists are drugs which prevent the aggregation ('clumping') of platelets and consequently reduce the formation of blood clots. These medications are used to prevent cardiovascular disease such as heart attacks and strokes in the general population. This review assessed if these medications would be useful in patients with diabetes. We included eight trials with 21,379 patients and a mean duration of follow‐up ranging from 365 to 913 days. Specific data for patients with diabetes were only available in full for one of these trials and partial data were available for two trials. Analysis of the available data demonstrated that adenosine‐diphosphate receptor antagonists (such as clopidogrel, prasugrel, ticagrelor, ticlopidine) were not more effective than other blood thinning drugs or placebo for death from any cause, death related to cardiovascular disease, heart attacks or strokes. There was no available information on the effects of adenosine‐diphosphate receptor antagonists on health‐related quality of life, adverse effects specially for people with diabetes, or costs. The use of adenosine‐diphosphate receptor antagonists in patients with diabetes needs to be guided by the information available from trials which included patients with and without diabetes. All future trials on adenosine‐diphosphate receptor antagonists should include data which relate specifically to patients with diabetes in order to inform evidence‐based clinical guidelines.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Symptomatic peripheral arterial disease in people with atherosclerosis can present as intermittent claudication, disabling pain on walking, or as critical limb ischaemia with pain at rest, ulceration, gangrene and the risk of losing a leg. One treatment option is to implant a graft or makeshift blood vessel to bypass a blockage in the main artery of the thigh. Using a section of the vein from the patient's leg is often better than artificial or prosthetic materials such as Dacron or polytetrafluoroethylene, which take up platelets that could lead to clotting that could block the graft. Other factors affecting the patency of the graft (how long the bypass remains open) include length of the bypass, site where the graft connects to the existing artery and blood flow out of the graft. Stenosis (narrowing) of the graft most frequently occurs at the surgical connections because of hyperplasia, or an increase in the number of smooth muscle cells, into the inner layer of the vessel, often followed by the formation of a thrombosis (clot) at the stenotic site.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

How do antiplatelet agents compare in acute coronary syndromes managed medically?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: November 10, 2011

Anti-clotting medication is used to prevent blood clots from forming, and therefore lower the risk of certain cardiovascular diseases like heart attacks and strokes. As the name suggests, they make sure that the blood does not clot as quickly.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 26, 2014

People with advanced kidney disease (end‐stage renal disease) need dialysis to perform kidney functions. In haemodialysis, blood is filtered through a machine. To allow a large enough passage for blood to flow between the person and the machine, an artery and a vein can be surgically joined (to form an arteriovenous fistula) or an artificial graft (a substitute for a vein) is used to join the artery to the vein. These access points might last for years but can become blocked or infected. This review investigates if additional medical therapy can keep these dialysis access points functioning.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

This review also showed that in patients with typical or diarrhoea associated haemolytic uraemic syndrome, there are no interventions that are superior to supportive therapy which includes control of fluid and electrolyte imbalance, use of dialysis if required, control of hypertension and blood transfusion as required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Low doses of aspirin do help prevent pre‐eclampsia, and some of its complications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Lower limb atherosclerosis can lead to blocked blood vessels causing pain on walking (intermittent claudication) or, if more severe, pain at rest, ulceration and gangrene (critical limb ischaemia).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

IgA nephropathy is a common kidney disease that often leads to decreased kidney function and may result ultimately in kidney failure for one‐third of affected people. The cause of IgA nephropathy is not known, although most people with the disease have abnormalities in their immune system. We identified 32 studies enrolling 1781 patients that met our inclusion criteria. This review found that if people with IgA nephropathy receive immunosuppressive drugs, particularly steroids, they may be less likely to develop kidney failure needing dialysis or transplantation. Few studies were available and the harms of therapy are currently not well understood. Larger placebo‐controlled studies are now needed to be certain about the benefits and hazards of steroids on outcomes in IgA nephropathy and to identify which specific patients might benefit most from the treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Peripheral arterial disease of leg arteries can progressively cause leg pain on walking, pain at rest, ulcers and gangrene because of reduced blood flow. An inflatable balloon catheter inserted into the artery is used to widen and unblock the affected artery (termed angioplasty) yet reoccurrence of narrowing (restenosis) or obstruction (reocclusion) frequently occurs because of platelet clumping (aggregation) and activated blood clotting in the damaged blood vessel. This review of 22 randomised clinical trials, with a combined total of 3529 patients, set out to determine if any drug was more effective than another in preventing occlusion or restenosis of the artery after the blood vessels have been surgically widened. For the majority of comparisons, only one study was available. Evidence suggests that some drugs which reduce platelet aggregation, such as higher‐dose aspirin, can reduce the rate of reocclusion six months after surgery, but evidence on associated side effects and for longer‐term restenosis rates is scarce. There is also some evidence of variation in effect according to different drugs, with reocclusion/restenosis rates lower in people taking cilostazol compared with ticlopidine 12 months after surgery and, in patients with more severe disease, those taking low molecular weight heparin in addition to aspirin compared with aspirin alone. Batroxobin plus aspirin compared with aspirin alone may be an effective treatment in diabetic patients. However, available trials are generally small and of variable quality and side effects of drugs are not consistently addressed. Further good quality, large‐scale randomised controlled trials, grouped by severity of disease, are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Peripheral arterial disease (PAD) refers to the blocking of large arteries. Patients with peripheral arterial disease as a result of narrowing of the arteries in the legs may present with cramping pain in the legs or buttocks on walking; this is also known as intermittent claudication (IC). This group of patients are at high risk of a heart attack, stroke and death. Treatment often involves stopping cigarette smoking and the optimising of other risk factors such as diabetes, high blood pressure and cholesterol. Another treatment often used to reduce the risk of heart attacks and strokes in patients with IC is antiplatelet treatment. Antiplatelets make the blood less sticky and therefore block the formation of blood clots, thereby preventing blockages in arteries which can cause heart attacks and strokes. Antiplatelet treatments include drugs such as aspirin, clopidogrel and dipyridamole, but there is limited evidence to date on the benefits of antiplatelet therapy in patients with IC. Twelve studies with a total of 12,168 patients were included in this review. The analyses show that, in patients with IC, antiplatelet agents reduced the risk of death from all causes, and from heart attack and stroke combined when compared with placebo. When aspirin was compared with other antiplatelet agents, there was some evidence that the alternative antiplatelet had a more beneficial effect in reducing all cause mortality or of suffering a cardiovascular event such as heart attack or stroke. However, this was based on only two trials. Antiplatelet usage, however, does increase the risk of indigestion and may also increase risk of major bleeding events. Despite its widespread use, the evidence for first line use of aspirin in patients with IC is weak and further research is required to determine whether aspirin would be better replaced by a different class of antiplatelet agent which has a greater beneficial effect with fewer side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Henoch‐Schönlein Purpura (HSP) causes inflammation of small blood vessels in children and affects approximately 20/100,000 children annually. Symptoms and signs include a purpuric skin rash (which comprises small spots and larger bruises), abdominal pain, gastrointestinal bleeding, joint pain and swelling, facial swelling and evidence of kidney disease with blood and protein in the urine. Kidney disease occurs in about one third of children with HSP. In the majority this is mild (small amounts of blood in the urine only) and resolves completely but a few children have persistent kidney disease that can progress to kidney failure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Blood clots can be formed by clotting proteins (coagulation factors) and sticky blood cells (platelets). Oral anticoagulants such as warfarin are drugs that can prevent clot formation by blocking the clotting proteins. Other drugs, like aspirin, can also reduce clotting by blocking the platelets. Warfarin is better than aspirin in patients with heart failure who have abnormal heart rhythm (atrial fibrillation). Aspirin is known to be helpful in patients with heart failure with normal (sinus) rhythm, whose heart arteries are narrowed. This condition is a common cause of heart failure, so doctors often advise patients with a normal rhythm to take aspirin. Arguably, people with heart failure with a normal rhythm are at increased risk of clotting due to slower blood flow in the heart, similarly to people with an abnormal rhythm. Also, blood clots (thromboembolism) in the lungs, legs and brain (ischaemic stroke) lead to disability and death of patients with heart failure. Several studies have tried to find out whether all heart failure patients should receive oral anticoagulants, but the debate is still open.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

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