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 .
Efficacy of combination antiplatelet therapy and nicardipine for chronic cerebral infarction.
To prevent recurrence of cerebral infa rct ion ( CI ) , the efficacy of antiplatelet therapy , when used in combination with a calcium antagonist , was examined . The study subjects were 57 chronic CI patients ( 40 men , 17 women ; mean age , 68.5 years ) who experienced either CI or its recurrence more than 3 months before the start of the study . They were r and omly allocated into one of the following four groups for the 8-week study ; group A -- ticlopidine hydrochloride 200 mg once daily and nicardipine hydrochloride 20 mg three times daily ( TID ) ; group B -- ticlopidine hydrochloride 200 mg once daily ; group C -- aspirin 81 mg once daily and nicardipine hydrochloride 20 mg TID ; or group D -- aspirin 81 mg once daily . Platelet aggregation was measured before treatment and 4 and 8 weeks after the initiation of each therapy by using adenosine diphosphate ( ADP ) ( 2 microM and 0.5 microM ) and collagen ( 2 micrograms/mL ) , and evaluated in terms of percent maximum platelet aggregation . Results showed significant suppression of 2.0 microM ADP platelet aggregation in groups A , B , and C. At 0.5-microM ADP , only groups A and B showed significant platelet aggregation suppression . All groups showed significant suppression of collagen platelet aggregation . In comparing single therapy with combination therapy , groups A and B were not significantly different from one another after 4 or 8 weeks in 2-microM ADP or collagen platelet aggregation suppression . In contrast , group C had significantly greater suppression of both 2-microM ADP and collagen aggregations compared with group D. In conclusion , nicardipine hydrochloride administration with aspirin may be a useful alternative therapy for the prevention of CI recurrence
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 .