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—Pentoxifylline Combination in the Treatment of Atherosclerosis and the Prevention of Cerebrovascular Accidents
This r and omized , double-blind study on 79 patients reported the efficacy of ticlopidine – pentoxifylline combination in the treatment of  atherosclerosis  and the prevention of  cerebrovascular accidents .  Comparisons were made with aspirin – dipyridamole – buflomedil and buflomedil – placebo combinations as controls . Global symptoms , sensorimotor disorders and vertigo were improved in all treatment groups , although improvement tended to be more pronounced with ticlopidine – pentoxifylline . None of the groups showed any change in stenosis or vessel wall rigidity although ticlopidine – pentoxifylline  reduced flow irregularity . This combination therapy also normalized the direction of flow in the ophthalmic artery in 46.2 % of patients with retro grade flow prior to treatment , compared with 30.0 % following aspirin – dipyridamole – buflomedil and 28.6 % following buflomedil – placebo administration . Significantly fewer cerebrovascular accidents occurred after treatment with ticlopidine – pentoxifylline . In conclusion , ticlopidine – pentoxifylline  showed good therapeutic efficacy against atherosclerosis and a preventative effect against new cerebrovascular accidents . This therapy was well tolerated
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 .