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Clopridogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack

Methodology Score: 4 /5                
Usefulness Score: 3.5/5

Wang Y, Johnston SC, Wang Y.
N Engl J Med. 2013 Oct 3;369(14):1376-7.

This multicenter randomized-control trial of 5,100 patients with TIA/minor stroke treated within 24 hours found clopidogrel and aspirin was superior to aspirin alone for secondary prevention of stroke within 90 days (ARR 3.5%, HR 0.68, 95% CI 0.57 - 0.81,p <0.001), without increasing the risk of significant hemorrhage (0.3% in both groups.) JC attendees appreciated the strong methodology, with successful and appropriately stratified randomization and an acceptable loss to follow-up.  However, the generalizability to our patient population was questioned as other secondary stroke prevention practices differ in China. 
By: Dr. Layli Sanaee
(Presented January 2014)

Epi lesson: Verifying the power of an RCT

The power of a study is defined as “the ability of a study to detect an effect or association if one really exists in a wider population.” Two key questions in determining whether an RCT is adequately powered are: 1) was the sample size detailed for the primary outcome? 2) Is the effect size consistent with the minimally clinically important difference (MCID) used in the sample size calculation? 
By: Dr. Lisa Calder


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