A Randomized Trial Comparing Ticlopidine Hydrochloride with Aspirin for the Prevention of Stroke in High-Risk Patients

Abstract

We report the results of the Ticlopidine Aspirin Stroke Study, a blinded trial at 56 North American centers that compared the effects of ticlopidine hydrochloride (500 mg daily) with those of aspirin (1300 mg daily) on the risk of stroke or death. The medications were randomly assigned to 3069 patients with recent transient or mild persistent focal cerebral or retinal ischemia. Follow-up lasted for two to six years. The three-year event rate for nonfatal stroke or death from any cause was 17 percent for ticlopidine and 19 percent for aspirin--a 12 percent risk reduction (95 percent confidence interval, -2 to 26 percent) with ticlopidine (P = 0.048 for cumulative Kaplan-Meier estimates). The rates of fatal and nonfatal stroke at three years were 10 percent for ticlopidine and 13 percent for aspirin--a 21 percent risk reduction (95 percent confidence interval, 4 to 38 percent) with ticlopidine (P = 0.024 for cumulative Kaplan-Meier estimates). Ticlopidine was more effective than aspirin in both sexes. The adverse effects of aspirin included diarrhea (10 percent), rash (5.5 percent), peptic ulceration (3 percent), gastritis (2 percent), and gastrointestinal bleeding (1 percent). With ticlopidine, diarrhea (20 percent), skin rash (14 percent), and severe but reversible neutropenia (less than 1 percent) were noted. The mean increase in total cholesterol level was 9 percent with ticlopidine and 2 percent with aspirin (P less than 0.01). The ratios of high-density lipoprotein and low-density lipoprotein to total cholesterol were similar in both treatment groups. We conclude that ticlopidine was somewhat more effective than aspirin in preventing strokes in this population, although the risks of side effects were greater.

Antithrombotic therapy in hypertension: a Cochrane Systematic review

“…[25][26][27][28][29] A further publication was excluded due to the inability to acquire the relevant data. 30 Most of the excluded trials were less than 1-month duration; in particular, the five GPIIb/IIIa inhibitor trials were only observing the effects over a few days. We did not consider that this observational period would be sufficient to make any meaningful statements about the prevention of thromboembolic events in hypertensive patients.…”

Pharmacokinetic Drug Interaction between Carvedilol and Ticlopidine in Rats

“…It has been tried in a variety of platelet-dependent disease states (Gent et al, 1989;Hass et al, 1989;Janzon et al, 1990). Indeed, several recent reviews recommend ticlopidine as a valuable alternative when patients cannot tolerate aspirin (Verhaeghe, 1991;Ito et al, 1992;Solomon and Hart, 1994;Buur et al, 1997;Haynes et al, 1998;Ko et al, 2000).…”

Ticlopidine Alone Versus Ticlopidine Plus Aspirin for Preventing Recurrent Stroke

“…The efficacy of ticlopidine has also been demonstrated in several studies (3,(7)(8)(9). These drugs are usually administered as monotherapy, but a combination of aspirin and ticlopidine is also used with the aim of achieving a more potent antiplatelet effect (10)(11)(12)(13).…”