Ticlopidine Alone Versus Ticlopidine Plus Aspirin for Preventing Recurrent Stroke

Ito, Eiichi; Takahashi, Akira; Yamamoto, Hiroko; Kuzuhara, Shigeki; Uchiyama, Shinichiro; Nakajima, Masahiro

doi:10.2169/internalmedicine.42.793

Cited by 19 publications

(9 citation statements)

References 14 publications

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“…A systematic review provides therefore stronger evidence. Sorensen et al 50 Bousser et al 6 Fields et al 22 Helmers et al 28 Boysen et al 7 Gent et al (CAPRIE study) 24 Lowenthal et al 34 Norrving et al 40 Farrel et al 21 Gent et al (CATS study) 25 Diener et al (ESPS study) 17 MacMahon et al 35 Gates et al 23 Matias-Guiu et al 38 Ito et al 30 Diener et al (MATCH study) 18 Toole et al 51 Collins et al 14 Chimowitz et al 12 Ovbiagele et al 42 Boysen et al (ExSTROKE study) 8 Figure S3. Forest plot of the meta-analysis of the risk of MI after TIA/IS in hospital-based studies.…”

Section: -6a Was the Follow Up Of Subjects Complete Enough?mentioning

confidence: 99%

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Boulanger

Béjot

Rothwell

et al. 2018

JAHA

121

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BackgroundUncertainties remain about the current risk of myocardial infarction (MI) after ischemic stroke or transient ischemic attack.Methods and ResultsWe undertook a systematic review to estimate the long‐term risk of MI, compared to recurrent stroke, with temporal trends in ischemic stroke/transient ischemic attack patients. Annual risks and 95% confidence intervals (95% CI) of MI and recurrent stroke were estimated using random‐effect meta‐analyses. We calculated incidence ratios of MI/recurrent stroke, for fatal and nonfatal events, using similar analyses. Rate ratios for MI in patients with potential risk factors compared to those without were calculated using Poisson regression.A total of 58 studies (131 299 patients) with a mean (range) follow‐up of 3.5 (1.0‐10.0) years were included. The risk of MI was 1.67%/y (95% CI 1.36‐1.98, P het<0.001 for heterogeneity) and decreased over time (P int=0.021); 96% of the heterogeneity between studies was explained by study design, study period, follow‐up duration, mean age, proportion of patients on antithrombotic therapy, and incident versus combined ischemic stroke/transient ischemic attack. The risk of recurrent stroke was 4.26%/y (95% CI 3.43‐5.09, P het<0.001), with no change over time (P int=0.63). The risk of fatal MI was half the risk of recurrent strokes ending in fatality (incidence ratio=0.51, 95% CI 0.14‐0.89, P het=0.58). The risk of nonfatal MI was 75% smaller than the risk of recurrent nonfatal stroke (incidence ratio=0.25, 95%CI 0.02‐0.50, P het=0.68). Male sex, hypertension, coronary and peripheral artery diseases were associated with a doubled risk of MI.ConclusionsAfter ischemic stroke/transient ischemic attack, the risk of MI is currently <2%/y, and recurrent stroke is a more common cause of death than MI.

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Section: -6a Was the Follow Up Of Subjects Complete Enough?mentioning

confidence: 99%

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Boulanger

Béjot

Rothwell

et al. 2018

JAHA

121

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“…Fifty‐five articles were reviewed by full text for details, and 31 of those were excluded. Finally, a total of 24 RCTs with 85 667 patients were included in the present network meta‐analysis . Tables and summarize the characteristics of the 24 included trials.…”

Section: Resultsmentioning

confidence: 99%

“…Tables and summarize the characteristics of the 24 included trials. The following antiplatelet therapies were tested in the trials: cilostazol versus aspirin (3 trials with 3459 patients), clopidogrel versus aspirin (1 trial with 6431 patients), dipyridamole versus aspirin (1 trial with 3303 patients), sarpogrelate versus aspirin (1 trial with 1499 patients), terutroban versus aspirin (1 trial with 19 100 patients), ticlopidine versus aspirin (4 trials with 5488 patients), ticlopidine versus clopidogrel (1 trial with 1151 patients), triflusal versus aspirin (2 trials with 2536 patients), aspirin plus clopidogrel versus aspirin (2 trials with 7340 patients), aspirin plus clopidogrel versus clopidogrel (1 trial with 7599 patients), aspirin plus dipyridamole versus aspirin (5 trials with 8622 patients), aspirin plus dipyridamole versus clopidogrel (1 trial with 20 332 patients), aspirin plus dipyridamole versus dipyridamole (2 trials with 3490 patients), and aspirin plus ticlopidine versus ticlopidine (1 trial with 270 patients) …”

Section: Resultsmentioning

confidence: 99%

“…The use of antiplatelet agents is the standard treatment for patients with noncardioembolic ischemic stroke or transient ischemic attack (TIA) . A number of randomized controlled trials (RCTs) have tested different antiplatelet mono‐ and dual therapies in secondary prevention after ischemic stroke or TIA; however, comparisons of some antiplatelet therapies are currently lacking.…”

Section: Introductionmentioning

confidence: 99%

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Long‐Term Antiplatelet Mono‐ and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta‐Analysis

Xie

Zheng

Zhong

et al. 2015

JAHA

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BackgroundThe latest guidelines do not make clear recommendations on the selection of antiplatelet therapies for long-term secondary prevention of stroke. We aimed to integrate the available evidence to create hierarchies of the comparative efficacy and safety of long-term antiplatelet therapies after ischemic stroke or transient ischemic attack.Methods and ResultsWe performed a network meta-analysis of randomized controlled trials to compare 11 antiplatelet therapies in patients with ischemic stroke or transient ischemic attack. In December 2014, we searched Medline, Embase, and the Cochrane Library database for trials. The search identified 24 randomized controlled trials including a total of 85 667 patients with antiplatelet treatments for at least 1 year. Cilostazol significantly reduced stroke recurrence in comparison with aspirin (odds ratio 0.66, 95% credible interval 0.44 to 0.92) and dipyridamole (odds ratio 0.57, 95% credible interval 0.34 to 0.95), respectively. Cilostazol also significantly reduced intracranial hemorrhage compared with aspirin, clopidogrel, terutroban, ticlopidine, aspirin plus clopidogrel, and aspirin plus dipyridamole. Aspirin plus clopidogrel could not significantly reduce stroke recurrence compared with monotherapies but caused significantly more major bleeding than all monotherapies except terutroban. The pooled estimates did not change materially in the sensitivity analyses of the primary efficacy outcome.ConclusionsLong-term monotherapy was a better choice than long-term dual therapy, and cilostazol had the best risk–benefit profile for long-term secondary prevention after stroke or transient ischemic attack. More randomized controlled trials in non–East Asian patients are needed to determine whether long-term use of cilostazol is the best option for the prevention of recurrent stroke.

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“…This recommendation was supported by four citations [1][2][3][4] , which included a systematic review and meta-analysis; this was used as the starting point for our PubMed search. 4 The meta-analysis focused on seven randomized, controlled studies 1,[5][6][7][8][9][10] ; that included patients with recent history of stroke or transient ischemic attack (TIA); and that compared DPT versus monotherapy. The meta-analysis indicated that DPT was superior to aspirin alone, but not to clopidogrel alone, and that dual anti-platelet therapy was more harmful than clopidogrel.…”

Section: Related Literaturementioning

confidence: 99%

Clopidogrel alone is safer than clopidogrel and aspirin for secondary prevention of acute ischemic stroke

2017

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Ticlopidine Alone Versus Ticlopidine Plus Aspirin for Preventing Recurrent Stroke

Abstract: Objective To compare the efficacy and safety of two antiplatelet regimens, ticlopidine alone (200 mg daily) and ticlopidine (100 mg daily) plus aspirin (81 mg daily), in patients with ischemic stroke from the Tokai district of Japan.

Cited by 19 publications

References 14 publications

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Long‐Term Antiplatelet Mono‐ and Dual Therapies After Ischemic Stroke or Transient Ischemic Attack: Network Meta‐Analysis

Clopidogrel alone is safer than clopidogrel and aspirin for secondary prevention of acute ischemic stroke

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