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ID
20426
Description
The purpose of the trial is to determine if extended-release dipyridamole + aspirin [Aggrenox, Asasa ntin] is superior to clopidogrel [Plavix], and if telmisartan [Micardis, Gliosartan, Kinzal, Kinzalm ono, Predxal, Pritor, Samertan, Telmisartan] is superior to placebo, in the presence of background antihypertensive therapy, in prevention of a second stroke in patients who have recently suffered a stroke and therefore are at high risk of suffering another one. Source & Descriptions: https://clinicaltrials.gov/ct2/show/NCT00153062?term=NCT00153062&rank=1
Link
https://clinicaltrials.gov/ct2/show/NCT00153062?term=NCT00153062&rank=1
Keywords
Versions (2)
- 2/22/17 2/22/17 -
- 4/3/17 4/3/17 -
Uploaded on
February 22, 2017
DOI
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License
Creative Commons BY-NC 3.0
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Myocardial Infarction Report Form PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062
Myocardial Infarction Report Form PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062
Similar models
Myocardial Infarction Report Form PRoFESS - Prevention Regimen For Effectively Avoiding Second Strokes NCT00153062
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Myocardial Infarction Report Form
C0027051 (UMLS CUI-1)
C1516308 (UMLS CUI-2)
C1516308 (UMLS CUI-2)
Date
Item
1. Date of MI event (dd mon yy)
date
C0011008 (UMLS CUI [1,1])
C0027051 (UMLS CUI [1,2])
C0027051 (UMLS CUI [1,2])
Chest Pain
Item
2. Chest pain?
boolean
C0008031 (UMLS CUI [1])
Item
If `YES` please indicate whether typical or atypical chest pain
integer
C0027051 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,2])
CL Item
Typical (1)
CL Item
Atypical (2)
Patient on study medication
Item
3. Was the patient on study medication within the 7 days prior to event?
boolean
C0013227 (UMLS CUI [1])
Item
If no indicate which medication the patient was not taking (Please indicate all that apply)
integer
C2348235 (UMLS CUI [1])
Code List
If no indicate which medication the patient was not taking (Please indicate all that apply)
CL Item
Bottle A (1)
CL Item
Bottle B (2)
CL Item
Blister Card C (3)
CL Item
Blister Card D (4)
ECG Changes
Item
4. is infarction documented by ECG changes.
boolean
C0855329 (UMLS CUI [1])
details of ECG
Item
If Yes, please provide details of ECG
text
C1522508 (UMLS CUI [1])
CL Item
Anterior (1)
CL Item
Inferior (2)
CL Item
Lateral (3)
CL Item
Anterolateral (4)
CL Item
Posterior (5)
CL Item
None (6)
CL Item
Anterior (1)
CL Item
Inferior (2)
CL Item
Lateral (3)
CL Item
Anterolateral (4)
CL Item
Posterior (5)
CL Item
None (6)
CL Item
Anterior (1)
CL Item
Inferior (2)
CL Item
Lateral (3)
CL Item
Anterolateral (4)
CL Item
Posterior (5)
CL Item
None (6)
CL Item
Anterior (1)
CL Item
Inferior (2)
CL Item
Lateral (3)
CL Item
Anterolateral (4)
CL Item
Posterior (5)
CL Item
None (6)
bundle branch block
Item
5. New bundle branch block (BBB)?
boolean
CL Item
Right BBB (1)
CL Item
Left BBB (2)
CL Item
Sinus (1)
CL Item
Atrial fib/flutter (2)
CL Item
Other (specify) (3)
Coronary Intervention
Item
7. Was coronary intervention done within the 3 days prior to the event?
boolean
Myocardial Infarction
Item
8. Was myocardial infarction confirmed by enzymes or biomarkers?
boolean
CL Item
Peak CK (9)
CL Item
Peak CK-MB (10)
CL Item
Peak LDH (11)
CL Item
Peak AST (12)
CL Item
Troponin T (13)
CL Item
Troponin I (14)
CL Item
Peak CK (9)
CL Item
Peak CK-MB (10)
CL Item
Peak LDH (11)
CL Item
Peak AST (12)
CL Item
Troponin T (13)
CL Item
Troponin I (14)
Hospitalization
Item
1. Did the vent lead to hospitalization. If yes please complete the Hospitalization Report Form.
boolean
C0019993 (UMLS CUI [1])
Fatal Event
Item
2. Was the event fatal (death within 28days). If yes please complete Death Report Form
boolean
Item Group
Please remember to fax Supporting Documentation clearly identified with the patient number
Item
3. Please indicate which supporting documentation has been supplied:
integer
Code List
3. Please indicate which supporting documentation has been supplied:
CL Item
ECGs (1)
CL Item
Hospital discharge summaries (2)
CL Item
Clinical description of event (3)
CL Item
Other (4)
Invenstigator´s Declaration
Item
3. Invenstigator´s Declaration By signing and dating this page, I declare that I have reviewed for accuracy all case report form pages for this patient; the information contained on these pages accurately reflects the medical record including the results of tests and evaluations performed in the dates specified.
text
Investigator´s signature
Item
Investigator´s signature
text
C2346576 (UMLS CUI [1])
Date of Signature
Item
Date of Signature
date
C0011008 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C1519316 (UMLS CUI [1,2])