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 .
Ticlopidine versus aspirin after myocardial infarction (STAMI) trial.
OBJECTIVES We sought to compare the efficacy of aspirin and ticlopidine in survivors of acute myocardial infa rct ion ( AMI ) treated with thrombolysis . BACKGROUND The role of ticlopidine in secondary prevention after AMI has not yet been explored . METHODS Of 4,696 patients with AMI treated with thrombolysis who were screened , 261 died in the hospital ( 5.6 % ) and 1,470 were enrolled in this r and omized , double-blind , multicenter trial and allocated to treatment with either aspirin ( 160 mg/day ) or ticlopidine ( 500 mg/day ) . The most frequent reasons for exclusion were refusal to give informed consent , planned myocardial revascularization , risk of noncompliance with study procedures , need for anticoagulant therapy and contraindications to the study treatments . The primary end point was the first occurrence of any of the following events during the six-month follow-up : fatal and nonfatal AMI , fatal and nonfatal stroke , angina with objective evidence of myocardial ischemia , vascular death or death due to any other cause . RESULTS The primary end point was recorded in 59 ( 8.0 % ) of the 736 aspirin-treated and 59 ( 8.0 % ) of the 734 ticlopidine-treated patients ( p = 0.966 ) . Vascular death was the first event in five patients taking aspirin and in six patients taking ticlopidine ( 0.7 % vs. 0.8 % ; p = NS ) ; nonfatal AMI in 18 and 8 ( 2.4 % vs. 1.1 % ; p = 0.049 ) ; nonfatal stroke in 3 and 4 ( 0.4 % vs. 0.5 % ; p = NS ) ; and angina in 33 and 40 ( 4.5 % vs. 5.4 % ; p = NS ) , respectively . The frequency of adverse reactions was not significantly different between the two groups . CONCLUSIONS No difference was found between the ticlopidine and aspirin groups in the rate of the primary combined end point of death , recurrent AMI , stroke and angina
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 .