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Triple Therapy May Be Best for Stroke Prevention

Combination of antiplatelets, ACE inhibitors, statins cuts tissue damage if stroke occurs

FRIDAY, April 28 (HealthDay News) -- A triple combination of antiplatelets, angiotensin-converting enzyme (ACE) inhibitors and statins may be effective in reducing the severity of a stroke and the extent of tissue damage in patients who are taking the medications to help prevent ischemic stroke, according to a report in the April 25 issue of Neurology.

To determine if the three common stroke prevention agents have an additive effect when taken together, M. Selim, M.D., Ph.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues retrospectively analyzed the outcome of 210 stroke patients who were previously taking various combinations of the drugs.

The average NIH Stroke Scale score was lower for patients taking the triple therapy compared with any dual therapy or antiplatelets alone. Also, 65 percent of patients on triple therapy showed neurologic improvement upon discharge, compared with 45 percent for the best dual combination therapy (antiplatelet and ACE inhibitor), 38 percent for antiplatelets alone, and 33 percent for those taking none of the drugs. Patients on the triple therapy also had smaller mean diffusion-weighted imaging/perfusion-weighted imaging mismatch lesion volumes indicating a reduction in at-risk tissue.

"This important study adds to the growing evidence that statins and ACE inhibitors may be useful as neuroprotective agents in the setting of acute ischemic stroke," write the authors of an accompanying commentary. Both the study authors and the commentators agree that adequately powered randomized trials are necessary to validate the results.

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