Compared with aspirin , thienopyridines significantly reduced gastrointestinal adverse effects .
However , thienopyridines increased the odds of skin rash and diarrhoea , ticlopidine more than clopidogrel .
Allocation to ticlopidine , but not clopidogrel , significantly increased the odds of neutropenia .
The thienopyridine derivatives are at least as effective as aspirin in preventing serious vascular events in patients at high risk , and possibly somewhat more so .
However , the size of any additional benefit is uncertain and could be negligible .
Clopidogrel has a more favourable adverse effects profile than ticlopidine and so is the thienopyridine of choice .
BACKGROUND Aspirin is the most widely studied and prescribed antiplatelet agent for preventing serious vascular events , reducing the odds of such events among high vascular risk patients by about a quarter .
Thienopyridine derivatives inhibit platelet activation by a different mechanism and so may be more effective .
OBJECTIVES To determine the effectiveness and safety of thienopyridine derivatives ( ticlopidine and clopidogrel ) versus aspirin for preventing serious vascular events ( stroke , myocardial infa rct ion ( MI ) or vascular death ) in patients at high risk , and specifically in patients with a previous TIA or ischaemic stroke .
A randomized comparison of the effects of aspirin and clopidogrel on thrombotic risk factors and C-reactive protein following myocardial infarction: the CADET trial.
A r and omized , double-blind multicenter trial-the Clopidogrel and Aspirin : Determination of the Effects on Thrombogenicity ( CADET ) trial-was carried out to compare the effects of clopidogrel vs. aspirin on thrombotic variables and C-reactive protein ( CRP ) , over a 6-month period of treatment , in patients with an acute myocardial infa rct ion within the previous 3 - 7 days , who were not scheduled for major surgery including coronary artery bypass grafting . Patients ( n = 184 ) were r and omly allocated to aspirin ( 75 mg day(-1 ) ) or clopidogrel ( 75 mg day(-1 ) ) . Blood sample s were taken at baseline and then at clinic visits at 1 , 3 and 6 months . By 1 month , clottable and immunonephelometric fibrinogen , D-dimer , von Willebr and factor , factor VIII and CRP were significantly ( P < 0.05 ) reduced from baseline values in both treatment groups ; as well as tissue plasminogen activator antigen in the aspirin group only . At 6 months , there were no differences between treatment groups ( P > 0.05 ) for any of the variables , whether or not potential confounding variables were adjusted for . Similarly , there were no differences between treatments in the difference between baseline and final values for any of the variables . Aspirin and clopidogrel were thus found to have similar effects on thrombotic variables and CRP in this patient population
Compared with aspirin , thienopyridines significantly reduced gastrointestinal adverse effects .
However , thienopyridines increased the odds of skin rash and diarrhoea , ticlopidine more than clopidogrel .
Allocation to ticlopidine , but not clopidogrel , significantly increased the odds of neutropenia .
The thienopyridine derivatives are at least as effective as aspirin in preventing serious vascular events in patients at high risk , and possibly somewhat more so .
However , the size of any additional benefit is uncertain and could be negligible .
Clopidogrel has a more favourable adverse effects profile than ticlopidine and so is the thienopyridine of choice .
BACKGROUND Aspirin is the most widely studied and prescribed antiplatelet agent for preventing serious vascular events , reducing the odds of such events among high vascular risk patients by about a quarter .
Thienopyridine derivatives inhibit platelet activation by a different mechanism and so may be more effective .
OBJECTIVES To determine the effectiveness and safety of thienopyridine derivatives ( ticlopidine and clopidogrel ) versus aspirin for preventing serious vascular events ( stroke , myocardial infa rct ion ( MI ) or vascular death ) in patients at high risk , and specifically in patients with a previous TIA or ischaemic stroke .