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 .
Asymptomatic circulating cerebral emboli and cerebral blood flow velocity under aspirin and ticlopidine in patients with cerebrovascular disease.
Aspirin and ticlopidine are two commonly used drugs in the prevention of cerebral embolic ischemic events . No direct comparisons in a cross-over design of the effects of ticlopidine and aspirin on asymptomatic circulating cerebral microemboli are available . We investigated 53 patients with cerebrovascular disease . Twenty-six patients were dosed for 2 weeks , 300 mg aspirin once daily and then for 2 weeks , 250 mg ticlopidine twice daily . In 27 other patients the scheme was reversed . Transcranial Doppler monitoring ( both middle cerebral arteries simultaneously for 1 h were performed at the end of the two weeks . The signal was recorded on digitalised audio tapes and analyzed blinded off-line . The number of embolic signals per hour and vessel was 15.7 under aspirin and 11.7 under ticlopidine ( difference not significant ) . The correlation between the number of emboli under the two medications was high . The highest number of embolic signals was found in high grade carotid stenosis . In patients with a low number of embolic signals , reproducibility was low . A minimum of 7 embolic signals in one treatment group is required for further therapeutic drug trials to allow reasonable comparisons . This study may help to plan further therapeutic trials using emboli detection
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 .