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**-Intentiontotreatanalysis:RRR:6.4%(p=0.26)-Ontreatmentanalysis:RRR:9.5%(p=0.101)Theprotocolassumptionswere:-Efficacy:RRR=14%fortheprimaryendpoint,with80%power(alpha=0.05,2-sided)-Nosafetyassumptions******TheClopidogrelandAspirinforReductionofEmboliinSymptomaticcarotidStenosis(CARESS)Studyisarandomized,double-blind,controlledtrialof100patients.Itsprimaryobjectiveistoevaluatewhetherclopidogrelontopofacetylsalicylicacid(ASA)issuperiortoASAaloneinreducingtheincidenceofsilentcerebralmicroemboli(MES)detectedbyTCDinpatientswithrecentlysymptomaticcarotidstenosis.ThisslidekitcoverstheCARESStrialresults.Aslidekitcoveringtherationaleanddesignofthestudyisalsoavailableseparately.**Uponrandomization,patientsreceiveeithera300mgloadingdoseofclopidogrel(fourtablets),followedby75mgclopidogreloncedailyfromDay2toDay7±1,oramatchingplaceboloadingdose,andoncedailyplacebofromDay2toDay7±1.Patientsinbotharmsalsoreceive75mgASAoncedailyfromDay1toDay7±1(ontopofclopidogrelorplacebo).Allstudydrugsareadministeredorally.******Theanalysisshowedthatmostipsilateraleventsoccurredneartheconsideredstenosis,whichsuggeststhatthetherapyworkedontheareawherethesymptomaticstenosisoccurred.**ThisslideistakenfromapresentationmadebyDr.GrayElrodtfromBerkshireMedicalCenterinwesternMassachusetts.AtBerkshireMedicalCenter,theirgoalis100%implementationoftheinterventions.Theyviewanythinglessthan100%asa“medicalerror,”andthatpatient’streatmentisdiscussedatmortalityandmorbidityrounds–justlikeanyothermedicalmistake.InMassachusetts,theGWTGinterventionteamestimatedthatiftheinterventionswereimplementedwitheverypatient,everytime,theyestimatedthattheywouldsave782patientsannuallyfromdeathoranotherc
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