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Aspirin Dosing in Ischemic Stroke

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Universal Activity Number: 407-000-10-012-H01-P
CEUs 0.1
Audience: Pharmacist
Activity Type: Application-based
Issued date: 05/01/2010
Expiration date: 05/01/2013
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Article title:

Aspirin Dosing for the Prevention and Treatment of Ischemic Stroke: An Indication-Specific Review of the Literature

Author(s):
Goal
To review relevant primary literature and guideline recommendations to identify the minimum effective dosage of aspirin for the prevention and treatment of ischemic stroke in various at-risk patient populations.
Objectives
Upon completion of this CE article, the reader will be able to:
  1. Explain how the pathophysiological process of atherosclerosis leads to an increased risk of acute ischemic stroke. 
     
  2. Describe the mechanisms by which aspirin inhibits thrombogenesis. 
     
  3. Given a case study of an ischemic stroke patient, recommend an appropriate evidence-based dose of aspirin or an alternative antiplatelet agent for stroke prevention. 
     
  4. Analyze the available literature to determine an appropriate antithrombotic regimen for ischemic stroke prevention in at-risk patients. 
     
  5. Identify aspirin dosage thresholds for minor, major, and life-threatening bleeding risks.
Abstract
OBJECTIVE: To describe the pharmacology, pharmacokinetics, and efficacy of dexlansoprazole in the treatment of heartburn associated with nonerosive gastroesophageal reflux disease (GERD) and healing and maintenance of healing of all grades of erosive esophagitis (EE).

DATA SOURCES: Literature searches were conducted using MEDLINE Ovid (1950-December 2009, week 4) and EMBASE (1980-2009, week 53) using the term dexlansoprazole. References from articles obtained from the search were evaluated for other relevant citations.

STUDY SELECTION AND DATA EXTRACTION: All articles published in English evaluating the pharmacology, pharmacokinetics, efficacy, and adverse effect profile of dexlansoprazole were selected for inclusion.

DATA SYNTHESIS: Dexlansoprazole is the newest addition to the proton pump inhibitor (PPI) class and is approved for the treatment of heartburn associated with nonerosive GERD, healing of all grades of EE, as well as maintenance of healing of EE. Dexlansoprazole has a unique dual delayed-release formulation, which releases drug at 2 points in time; the first peak occurs 1-2 hours after administration and the second occurs within 4-5 hours after administration. In Phase 3 trials conducted in adults, researchers found that dexlansoprazole increases rates of healing of EE, as well as the maintenance of healing, compared to lansoprazole. Relief of heartburn symptoms was comparable among the dexlansoprazole and lansoprazole treatment groups. Common adverse effects of dexlansoprazole are similar to those of the other PPIs, including diarrhea, abdominal pain, nausea, upper respiratory infection,vomiting, and flatulence.

CONCLUSIONS: Dexlansoprazole provides another treatment option for the management of EE and symptoms of heartburn. Considering that the cost of dexlansoprazole is not favorable, further studies evaluating potential advantages over other agents are necessary to define the role of dexlansoprazole in the treatment of these conditions.

Key Words: dexlansoprazole, proton pump inhibitor.

Published Online, 6 April 2010, www.theannals.com, DOI 10.1345/aph.1M685.