Aspirin and extended-release dipyridamole versus clopidogrel for recurrent stroke

Background Recurrent stroke is a frequent, disabling event after ischemic stroke. This study compared the efficacy and safety of two antiplatelet regimens — aspirin plus extendedrelease 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.)

Don’t expect me to vote for you just because I like you, even if you do make me feel warm inside: a comparison of the validity of non-ipsative measures of party support

The inclusion of non-ipsative measures of party preference (in essence ratings for each of the parties of a political system) has become established practice in mass surveys conducted for election studies. They exist in different forms, known as thermometer ratings or feeling scores, likes and dislikes scores, or support propensities. Usually only one of these is included in a single survey, which makes it difficult to assess the relative merits of each. The questionnaire of the Irish National Election Study 2002 (INES2002) contained three different batteries of non-ipsative party preferences. This paper investigates some of the properties of these different indicators. We focus in particular on two phenomena. First, the relationship between non-ipsative preferences and the choices actually made on the ballot. In Ireland this relationship is more revealing than in most other countries owing to the electoral system (STV) which allows voters to cast multiple ordered votes for candidates from different parties. Second, we investigate the latent structure of each of the batteries of party preferences and the relationships between them. We conclude that the three instruments are not interchangeable, that they measure different orientations, and that one –the propensity to vote for a party– is by far preferable if the purpose of the study is the explanation of voters’ actual choice behaviour. This finding has important ramifications for the design of election study questionnaires.