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  Revêtement de polyéthyl...  
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Un ECR* en cours pourrait venir combler cette lacune.
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An upcoming RCT* may address the gap.
  iStent : un traitement ...  
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Un ECR comportant une période de suivi de 12 mois, auprès de 239 patients atteints de GAO léger à modéré, a évalué l’innocuité et l’efficacité du iStent. L’étude a comparé les patients subissant une chirurgie de la cataracte jumelée à la pose d’un iStent à des patients subissant seulement une chirurgie.
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A 12-month follow-up RCT3 involving 239 patients with mild to moderate OAG assessed the safety and efficacy of the iStent. The study compared patients receiving cataract surgery in combination with the iStent versus patients receiving cataract surgery alone. The authors reported that the patients who had the iStent implant experienced statistically and clinically significant benefits in reducing IOP with less medication. The safety profile for the two patient groups was similarly favourable. Follow-up at two years found significantly better IOP control in the iStent treatment group compared with the control group in patients not taking any medication for OAG.
  iStent : un traitement ...  
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Un ECR comportant un suivi de 12 mois chez 33 patients atteints de GAO ou d’hypertension oculaire a évalué les changements dans la dynamique de l’humeur aqueuse ainsi que l’efficacité et l’innocuité du iStent.
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A 12-month follow-up RCT6 of 33 patients with OAG or ocular hypertension evaluated the changes in aqueous humour dynamics, and the efficacy and safety of the iStent. The study population consisted of patients who received two iStents in combination with cataract surgery and patients who underwent cataract surgery alone. At one year, the authors indicated that the iStent group (n = 17) showed a clinically significant increase in trabecular outflow facility, significant IOP reduction, and a reduction in reliance on ocular medications compared with the control group (n = 16).
  L’ablation par radiofré...  
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Résultats : Au nombre des 968 résumés ou titres recensés dans le cadre de la stratégie de recherche documentaire, 111 études de recherche primaires (11 %) satisfaisaient aux critères d'inclusion, y compris 18 études sur les syndromes de pré-excitation, 22 études sur la TRINAV, dont l'une traitait également de syndromes de pré-excitation, 16 études sur le flutter auriculaire, neuf études portant sur d'autres formes de tachycardie auriculaire, 29 études traitant généralement de la FA et 18 études sur la TV. Il s'agissait surtout de rapports de cohortes provenant d'un seul centre. Seulement dix (9 %) des études étaient des ECR.
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Results: Of the 968 abstracts/citation titles identified through the literature search strategy, 111 primary research studies (11%) met the inclusion criteria. These consisted of 18 studies on the pre-excitation syndromes, 22 studies on AVNRT with one study also reporting on the pre-excitation syndromes, 16 studies on atrial flutter, nine studies related to other atrial tachycardias, 29 studies in general on AF, and 18 studies on VT. These studies were primarily single-centre cohort reports. Only ten of these studies (9%) were RCTs.
  Efficacité comparative ...  
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Dans le cadre de la présente étude méthodique, seuls des essais cliniques contrôlés et à répartition aléatoire (ECR) sur l’efficacité comparative de la rosiglitazone ou de la pioglitazone et d’autres antidiabétiques ont été sélectionnés par une vaste recherche documentaire.
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In this systematic review, only randomized controlled trials comparing the efficacy of rosiglitazone or pioglitazone with other anti-diabetic agents were selected from a broad literature search. Primary outcome measures were fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c). A total of 19 relevant trials were found, 11 rosiglitazone and eight pioglitazone trials. The observation period for most studies was 52 weeks or less.
  Antipsychotiques atypiq...  
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Du lot des ECR, 1113-24 se penchent sur la comparaison entre la clozapine associée à un autre antipsychotique et la clozapine en monothérapie. Ils ne détectent pas de différences statistiquement significatives entre les deux interventions sous les angles examinés, sauf du point de vue de l’échelle d’impression clinique globale d’amélioration (CGI-I), en vertu de laquelle la bithérapie renfermant la clozapine est légèrement mieux que la clozapine seule après 16 semaines de traitement.
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Eleven RCTs13-24 compared combination therapy involving clozapine (CLZ) versus CLZ monotherapy. There were no statistical differences between groups for any outcome, with the exception of the Clinical Global Impression Improvement (CGI-I) scale, where slightly greater improvement was seen in the CLZ combination arm compared with CLZ monotherapy at 16 weeks.
  Antipsychotiques atypiq...  
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Grâce au système d’alerte de publication d’ECR, maintenu jusqu’en mai 2011, nous avons repéré quatre études conformes aux critères d’admissibilité, mais les analyses de sensibilité, qui incorporent ces nouvelles données, ne changent rien vraiment aux résultats de l’étude méthodique.
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Meta-analyses were performed, where appropriate, to obtain pooled estimates of effect. Monthly RCT alerts were maintained until May of 2011. Four studies meeting the inclusion criteria were identified via these alerts, but sensitivity analyses incorporating the new data from these trials did not significantly affect the results of the analyses.
  Antipsychotiques atypiq...  
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Seulement un 10 des 30 ECR est mené auprès d’adolescents (âgés de 10 à 18 ans). Dans les études dont la population est adulte, la durée de la maladie au moment de l’étude va de 711 à 2212 ans (moyenne pondérée de 15,6 et écart-type [ET] de 4,8).
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Of the 30 included RCTs, only one10 was conducted in adolescents (aged 10 to 18 years). Baseline duration of illness for the adult studies ranged from 711 to 2212 years (weighted mean [SD] 15.6 [4.8]). A broad range of antipsychotic doses were used in the included trials. Common outcome measures included schizophrenia symptom scales (e.g., Positive and Negative Symptoms Scale [PANSS], Brief Psychiatric Rating Scale [BPRS] scores, Clinical Global Impression [CGI]), response rate, cognition, withdrawals, and serious adverse events. No evidence was available for relapse or remission rates.
  iStent : un traitement ...  
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Un ECR à double insu a comparé l’efficacité de diminution de la PIO procurée par la phacoémulsification seule ou jumelée au iStent, chez 36 patients5. Les résultats ont montré que les patients traités en conjonction avec le iStent présentait une PIO significativement plus basse et une diminution significative de l’usage d’hypotensifs oculaires; 67 % des patients ne faisaient pas appel aux médicaments 15 mois après l’opération, par rapport au groupe témoin.
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A double-blinded RCT compared the IOP-lowering efficacy of phacoemulsification alone and in combination with the iStent in 36 patients.5 Results showed that the iStent-treated patients experienced significantly lower IOP and a significant reduction in the use of ocular hypotensive drugs, with 67% of patients being medication free 15-months post-operatively compared with the control group. No adverse events were reported in the study group.
  Gestion optimale du tra...  
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Par opposition, les résultats des études primaires (deux ECR et cinq études non randomisées) indiquent l’allongement de la période durant laquelle le RIN se maintient dans l’écart thérapeutique dans le cadre de l’autosurveillance ou de l’autogestion, comparativement à la clinique d’anticoagulation, mais l’absence de différences avec les soins usuels.
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In contrast to the systematic reviews, results from additional primary studies (two RCTs, five non-randomized studies) indicated an increase in TTR with PST/PSM compared with specialized anticoagulation clinic care, but no difference compared with UC.
  Le sevelamer dans l’ins...  
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Nous avons effectué une étude méthodique pour relever la documentation pertinente en cherchant dans de multiples bases de données selon une stratégie définie et en faisant une recherche manuelle dans les revues scientifiques pertinentes. Les données sur l’efficacité théorique viennent d’essais cliniques randomisés (ECR).
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We did a systematic review to identify relevant literature, by searching multiple databases using a defined strategy, and by hand searching relevant journals. Evidence of efficacy was determined from randomized controlled trials (RCTs). Evidence of harm was determined from trials or registries where data was gathered prospectively. Ten RCTs with a total of 3,025 participants were included in the efficacy analysis; 28 prospective trials with a total of 3,983 participants were identified and eligible for the review of harm. One unpublished, randomized, unblinded study of 2,103 dialysis patients was designed to measure overall survival and cardiovascular mortality.
  Rapports d’examen rapid...  
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L’essai clinique majeur RELY, randomisé et comparatif (ECR), qui oppose le dabigatran et la warfarine, constate que le dabigatran à la dose de 110 mg comporte moins de risque d’hémorragie grave que la warfarine à une dose adaptée, ce qui ne serait pas le cas du dabigatran à la dose de 150 mg.
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Bleeding is typically the main safety issue of concern with all anticoagulants, including dabigatran. In RE-LY, the major randomized controlled trial (RCT) comparing dabigatran with warfarin, the risk of severe bleeding was reduced with the lower 110-mg dose of dabigatran compared with adjusted-dose warfarin, but there was no such reduction with the higher, 150-mg dose. However, there was evidence that in elderly patients there was no reduction in severe bleeding risk at either dose versus warfarin, and in the post-marketing period there was some evidence from case reports that elderly patients and/or those with severe renal impairment are at risk for serious bleeding events.
  Le sevelamer dans l’ins...  
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Nous avons effectué une étude méthodique pour relever la documentation pertinente en cherchant dans de multiples bases de données selon une stratégie définie et en faisant une recherche manuelle dans les revues scientifiques pertinentes. Les données sur l’efficacité théorique viennent d’essais cliniques randomisés (ECR).
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We did a systematic review to identify relevant literature, by searching multiple databases using a defined strategy, and by hand searching relevant journals. Evidence of efficacy was determined from randomized controlled trials (RCTs). Evidence of harm was determined from trials or registries where data was gathered prospectively. Ten RCTs with a total of 3,025 participants were included in the efficacy analysis; 28 prospective trials with a total of 3,983 participants were identified and eligible for the review of harm. One unpublished, randomized, unblinded study of 2,103 dialysis patients was designed to measure overall survival and cardiovascular mortality.
  Les endoprothèses à  él...  
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Un ECR multinational, parrainé par l’industrie, comportant 479 patients atteints d’AP fémoro-poplitée au-dessus du genou, a comparé le Zilver PTX à l’angioplastie par ballonnet2. L’issue d’innocuité primaire fut atteinte, c’est-à-dire un taux de survie sans événement après 12 mois de 90,5 % chez les patients faisant parti du groupe de traitement avec le Zilver PTX, et de 83,9 % chez les patients du groupe témoin traités par angioplastie.
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An industry-sponsored, multinational RCT involving 479 patients with above-the-knee femoropopliteal PAD compared the Zilver PTX with balloon angioplasty.2 The primary safety end point was met, with an event-free survival rate at 12 months of 90.5% for patients in the Zilver PTX treatment group and 83.9% for patients in the angioplasty control group. Primary patency rate at 12 months was 82.7% in the Zilver PTX group and 32.7% in the angioplasty group.
  Examen méthodique d'étu...  
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Les avantages et désavantages relatifs des diverses techniques de CRVP ont été déterminés en examinant leur impact sur la qualité de vie, leurs complications, la mortalité, l’essoufflement (dyspnée) et la fonction pulmonaire. L’examen méthodique porte sur quatre essais cliniques contrôlés et randomisés (ECR) et dix études de cohortes comparant diverses techniques de CRVP.
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The relative benefit and harm of different LVRS procedures were determined by examining their impact on the quality of life (QoL), complications associated with treatment, mortality, shortness of breath (dyspnea) and pulmonary function. Four randomized controlled trials (RCTs) and 10 cohort studies comparing different LVRS procedures were identified.
  Antipsychotiques atypiq...  
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Les limites de l’étude méthodique relèvent de l’insuffisance et de la piètre qualité des données probantes. Les auteurs jugent que 27 des 30 ECR retenus pêchent par laxisme méthodologique. Les essais cliniques sont brefs et n’ont pas la puissance suffisante pour évaluer objectivement les aspects d’intérêt, particulièrement l’innocuité.
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Limitations of this systematic review include lack of and low quality of available evidence. Of the 30 included RCTs, 27 were rated as being of “poor” methodological quality. The trials were of short duration and had inadequate study power, particularly for safety outcomes.
  Les modificateurs de la...  
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Parmi les 79 articles, 24 répondaient aux critères d’inclusion du présent examen, soit six examens méthodiques, neuf ECR , cinq évaluations économiques et quatre ensembles de lignes directrices fondées sur des données probantes.
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The literature search identified 1,336 citations of which 75 were deemed potentially relevant. An additional 4 articles were identified from the grey literature. Of the 79 reports, 24 met the criteria for inclusion in this review: 6 systematic reviews, 9 RCTs, 5 economic evaluations, and 4 evidence-based guidelines.
  Analyse de l’efficacité...  
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En effet, il est établi que les résultats statistiquement significatifs seront présentés, alors que ceux sans importance statistique ne le seront probablement pas34. Comme ce n’est pas la totalité des ECR qui se prêtent à toutes les analyses, la puissance de celles-ci s’en trouve réduite.
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This review has limitations. Not all trial reports documented data on all of the outcomes of interest. This may introduce bias, because statistically significant results are more likely to be reported than non-statistically significant results.34 Not all RCTs could be included in the analyses for all outcomes, resulting in reduced power. A handful of clinical trials were used in quantitative data analysis, and the event rates that were reported for some clinical outcomes (such as stroke, major bleeds, and some adverse events) were low. The related computational issues may limit the analyses, and the results are interpreted with caution.
  Antipsychotiques atypiq...  
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Les ECR retenus examinent les stratégies thérapeutiques que voici :
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The selected RCTs studied the following treatment strategies:
  Gestion optimale du tra...  
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Nous avons recensé 18 études primaires, à savoir 6 essais cliniques comparatifs et randomisés (ECR) et 12 études non randomisées, qui satisfont les critères d’admissibilité. Elles ont été publiées dans la période allant de 2006 à 2011.
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Eighteen primary studies — six randomized controlled trials (RCTs) and 12 non-randomized studies — met inclusion criteria. All included primary studies (RCTs and non-randomized studies) were published between 2006 and 2011. Sample sizes ranged from 40 to 13,052.
  Les triptans dans la cr...  
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Aucun des ECR répertoriés ne portait sur l’étude de l’utilisation des triptans dans le traitement précoce de la migraine, ni dans le traitement des migraines légères, bien que cela soit d’usage dans la pratique actuelle.
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The generalizability of clinical evidence to current practice requires consideration. None of the RCTsidentified investigated the effect of triptan use for early treatment or mild migraine, although this is commonly encouraged in current practice. This practice could change the magnitude of observed responses from that seen in clinical trials. Switching to a different triptan, rather than continuing with the same triptan, is encouraged in current practice and may result in different success measures than that observed in clinical trials
  Gestion optimale du tra...  
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Les lignes directrices de pratique clinique publiées en 2008 par l’American College of Chest Physicians recommandent une démarche systématique et coordonnée dans la gestion de l’anticoagulation dans le cadre de services spécialisés par exemple7. Cette recommandation s’appuie sur une analyse documentaire exhaustive faisant ressortir la même divergence entre les ECR et les études observationnelles.
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Clinical practice guidelines produced by the ACCP in 2008 recommend a systematic and coordinated approach to anticoagulation therapy, using specialized anticoagulation management services as an example.7 This recommendation was based on a comprehensive literature review that showed a similar discrepancy between RCT and observational studies.
  Analyse de l’efficacité...  
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Parce que les données probantes issues des ECR ne sont d’aucune utilité pour répondre à certaines des questions de recherche, nous avons examiné des études observationnelles dont l’échantillon est de grande taille et le suivi, long.
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Because of the inadequate evidence found from RCTs to answer some of the research questions, observational studies with large sample sizes and longer follow-ups were considered. Many of these observational studies were retrospective, and non-random allocation of treatment and potential confounding by indication led to concerns about the reliability of results.
  iStent : un traitement ...  
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Une évaluation technologique réalisée en 20112 s’est penchée sur diverses nouvelles interventions pour le traitement du glaucome, incluant le iStent. Les auteurs ont estimé que les nouvelles approches démontraient un potentiel pour le traitement du GAO, mais qu’aucun ECR de puissance suffisante ne permettait de déterminer leur efficacité.
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A 2011 technology assessment2 evaluated a variety of novel glaucoma procedures, including the iStent. The authors found that although all the new approaches showed potential for the treatment of OAG, there were no RCTs of appropriate power to determine their efficacy.
  La chirurgie bariatriqu...  
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Un ECR à centre unique, sans insu, comportant une période de suivi de 12 mois, a comparé l’efficacité du TMC au TMC jumelé au PG ou à la gastrectomie longitudinale mis en œuvre dans le but d’améliorer la maîtrise glycémique chez 150 patients obèses atteints de diabète de type 2.
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A 12-month follow-up, single-centred, non-blinded RCT compared the effectiveness of SMT with SMT plus GB or sleeve gastrectomy as a means of improving glycemic control in 150 obese patients with type 2 diabetes mellitus. The authors reported that at 12-months, glycated hemoglobin levels of 6% were achieved in 12% of the SMT group versus 42% in the GB group, and 37% in the sleeve gastrectomy group. With the continued use of drugs to lower glucose, lipid and blood pressure levels decreased significantly in the BS groups but increased in patients receiving SMT alone.2
  RegJoint ‘” Un implant ...  
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Un ECR comportant un suivi de deux ans et comptant 52 patients atteints d’AR a comparé l’IBP à un implant en silicone. Les résultats de pertinence clinique étaient semblables entre les deux groupes. Toutefois, on a constaté une prévalence plus élevée de subluxations palmaires récidivantes dans le groupe BPI.
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A two-year follow-up RCT involving 52 patients with RA compared a BPI with a silicone implant. Clinically relevant outcomes were similar between the two groups. However, recurrent palmar subluxation was more prevalent in the BPI group. Implant fractures, cortical perforations, and osteolysis were more common in the silicone implant group. The surgical technique used for BPI arthroplasty was described by the study authors as somewhat laborious because of the need to fix the implant both to the metacarpal bone and the palmar plate.4
  RegJoint ‘” Un implant ...  
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Un ECR comprenant 35 patients atteints de déformations rhumatoïdes de l’avant-pied a comparé l’IBP à un groupe subissant une résection conventionnelle de la tête du métatarsien. À 3 et 12 mois, la performance clinique et le taux de complications du groupe d’IBP et du témoin étaient comparables5.
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An RCT involving 35 patients with rheumatoid forefoot deformities compared a BPI with a conventional metatarsal head resection group. Clinical performance and complication rates, at 3 and 12 months, were comparable between the BPI and the control group.5
  L’efficacité des inhibi...  
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Méta-analyse d'études comparatives randomisées (ECR) portant sur l'efficacité des IPP comparativement au placebo, aux antagonistes H2 ou aux agents stimulant la motilité gastrique.
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Outcome: Number of patients experiencing either no symptoms (excellent control) or a significant improvement in symptoms (combined good and excellent control).
  Analyse de l’efficacité...  
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Les études cliniques (ECR et études observationnelles) qui se penchent sur le sujet de la durée de traitement optimale mentionnent que le traitement de longue durée est plus avantageux que le traitement à brève échéance en cas de mise en place d’endoprothèses.
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Clinical studies (RCTs and observational studies) examining the optimal duration of clopidogrel therapy suggest that patients with stent placement benefit from the longer-term use of clopidogrel compared with short-term treatment. Studies indicated that the shorter time required for a reimbursement decision in a Canadian provincial drug reimbursement program for clopidogrel therapy is associated with better patient outcomes. One observational study20 implied the possibility of a clopidogrel rebound effect. The authors were unable to identify any study that could help answer the third (plus fourth and fifth), sixth, and thirteenth research question. Few studies examine the effectiveness of dipyridamole or ASA extended-release dipyridamole.
  Le Point sur le PCEM, n...  
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Annexe 8 : CONSORT : mode de présentation de l’ECR et du cheminement des participants de l’essai clinique
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Appendix 8: CONSORT Reporting Standard for Documenting Patient Flow
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