A randomised controlled trial of triple antiplatelet therapy (Aspirin, Clopidogrel and Dipyridamole) in the secondary prevention of stroke: safety, tolerability and feasibility

Background: Aspirin, dipyridamole and clopidogrel are effective in secondary vascular prevention. Combination therapy with three antiplatelet agents might maximise the benefit of antiplatelet treatment in the secondary prevention of ischaemic stroke. Methodology/Principal Findings: A randomised, parallel group, observer-blinded phase II trial compared the combination of aspirin, clopidogrel and dipyridamole with aspirin alone. Adult patients with ischaemic stroke or transient ischaemic attack (TIA) within 5 years were included. The primary outcome was tolerability to treatment assessed as the number of patients completing randomised treatment. Recruitment was halted prematurely after publication of the ESPRIT trial (which confirmed that combined aspirin and dipyridamole is more effective than aspirin alone). 17 patients were enrolled: male 12 (71%), mean age 62 (SD 13) years, lacunar stroke syndrome 12 (71%), median stroke/TIA onset to randomisation 8 months. Treatment was discontinued in 4 of 9 (44%) patients receiving triple therapy vs. none of 8 taking aspirin (p = 0.08). One recurrent stroke occurred in a patient in the triple group who was noncompliant of all antiplatelet medications. The number of patients with adverse events and bleeding complications, and their severity, were significantly greater in the triple therapy group (p,0.01). Conclusions/Significance: Long term triple antiplatelet therapy was asociated with a significant increase in adverse events and bleeding rates, and their severity, and a trend to increased discontinuations. However, the patients had a low risk of recurrence and future trials should focus on short term therapy in high risk patients characterised by a very recent event or failure of dual antiplatelet therapy.

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.