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Extra info for Clinical Evidence: Cardiovascular Disorders ; The International Source of the Best Available Evidence for Cardiovascular Health Care

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Vliegen HW, van der Wall EE, Niemeyer MG, et al. Long-term efficacy of diltiazem controlled release versus metoprolol in patients with stable angina pectoris. J Cardiovasc Pharmacol 1991;18(suppl 9):S55–S60. 26. Rehnqvist N, Hjemdahl P, Billing E, et al. Effects of metoprolol vs verapamil in patients with stable angina pectoris: the Angina Prognosis Study in Stockholm (APSIS). Eur Heart J 1996;17:76–81. [Erratum in: Eur Heart J 1996;17:483] 27. Hall R, Chong C. A double-blind parallel-group study of amlodipine versus long-acting nitrate in the management of elderly patients with stable angina.

03). 1 The review concluded that the sum of the evidence suggests no added cardiovascular benefit, and greater incidence of adverse effects, for aspirin doses greater than 325 mg daily. Some people are allergic to aspirin. Comment: People with unstable angina who are allergic or who do not respond to aspirin will need alternative antiplatelet treatment.  BMJ Publishing Group Ltd 2005 3 Cardiovascular disorders Angina (unstable) Cardiovascular disorders main/0209_new 30/09/05 Angina (unstable) OPTION CLOPIDOGREL/TICLOPIDINE Two RCTs found that adding clopidogrel to aspirin or ticlopidine to conventional treatment reduced mortality and myocardial infarction compared with aspirin alone or conventional treatment alone.

98; NNT 38; CI not provided). 97; NNT 34; CI not reported). 005; NNT 14; CI not reported). 10). 32 The difference was mainly due to reduced refractory angina with early intervention. 31 The fifth RCT found that early intervention increased bleeding events during the index admission, but the significance of this increase was not reported (8% with early intervention v 4% with conservative treatment). Comment: All trials have reported only short term and medium term follow up, so we cannot exclude a long term difference in effect between early invasive and early non-invasive strategies.

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