Be careful out there. Remember you need to know all this stuff.
http://www.docguide.com/clopidogrel-may-increase-fracture-risk-patients-who-have-had-stroke?hash=7e422beb&eid=35318&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c
Patients who have had a stroke, who are at an already increased risk
for fractures, may be at further increased risk if they are being
treated with the platelet-inhibitor clopidogrel, according to a
retrospective, cohort study presented at the American Society of Bone
and Mineral Research (ASBMR) 2013 Annual Meeting.
“Clinicians may not take care of patients’ bone health when they present with a stroke,” noted lead author Niklas RyeJørgensen,
MD, PhD, Copenhagen University Hospital Glostrup, Glostrup, Denmark,
speaking here on October 5. Most patients who have had a stroke, he
added, receive platelet inhibitor therapy with clopidogrel, which has
been shown to be associated with an increased risk of fracture.
Dr. Jorgensen and colleagues included 77,503 Danish patients who had
been prescribed clopidogrel during the years 1996 to 2008 as exposed
subjects. For each of these exposed subjects, 3 subjects of the same age
and gender were randomly selected as controls (n = 232,510).
Patients treated with clopidogrel had more strokes compared with the
control group (1.2% vs 0.9%, respectively), more ischaemic strokes (9.3%
vs 2.6%), and more transient ischaemic attacks (TIAs) (7.2% vs 2.3%).
Patients who have had a stroke had a significantly increased risk of
fractures, both in the haemorrhagic stroke group (hazard ratio [HR]:
1.34, P< .001) and the ischaemic stroke group (HR: 1.54, P< .001).
Patients who have had a TIA also had an increased risk of fractures (HR: 1.28, P< .001), as did clopidogrel users (HR: 1.05, P<
.001), although the researchers note that the contribution of
clopidogrel treatment was much less than the contribution of the stroke
itself.
A number of factors contributed to an increased risk of fractures in
patients who have had a stroke, the researchers outlined. Patients who
have had a stroke have several risk factors for bone loss, including
decompensation, treatment with agents that can lead to increased bone
resorption (and thereby bone loss), vitamin D insufficiency, and an
increased risk of falls, primarily because of changes in these values
and changes in muscular function.
“We should definitely recommend to clinicians to take care of bone health in stroke patients,” Dr. Jorgensen concluded.
Patients in this study were culled from 3 databases in Denmark: the
National Hospital Discharge Register, the Psychiatric Central Register,
and the National Pharmacological Database of the Danish Health &
Medicines Agency.
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