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 clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents.
OBJECTIVES The aim of the present study was to compare clopidogrel and ticlopidine after coronary stenting with regard to cardiovascular death during long-term follow-up . BACKGROUND R and omized trials comparing clopidogrel and ticlopidine with a restricted use of intravenous glycoprotein IIb/IIIa inhibition have reported a trend toward a higher incidence of thrombotic stent occlusion with clopidogrel at 30 days . METHODS After successful coronary stent implantation , 700 patients with 899 lesions were r and omly assigned to receive a four-week course of either 500 mg ticlopidine ( n = 345 ) or 75 mg clopidogrel ( n = 355 ) in addition to 100 mg aspirin .  Cardiovascular death was the primary end point and was recorded during a median follow-up period of 28 months . RESULTS Cardiovascular death occurred in eight patients with ticlopidine versus 26 patients with clopidogrel ( hazard ratio with ticlopidine compared with clopidogrel , 0.30 ; 95 % confidence interval [ CI ] , 0.14 to 0.66 ; p = 0.003 ) . After adjustment for co-variables , ticlopidine reduced the risk of cardiovascular death by 63 % compared with clopidogrel . The combined end point of cardiovascular death or nonfatal myocardial infa rct ion was present in 19 patients assigned ticlopidine , compared with 40 patients assigned clopidogrel ( hazard ratio , 0.45 ; p = 0.005 ) . The hazard ratio for all-cause mortality with ticlopidine as compared with clopidogrel was 0.30 ( 95 % CI , 0.14 to 0.64 ; p = 0.002 ) . CONCLUSIONS After the placement of coronary artery stents in unselected patients , ticlopidine was associated with a significantly lower mortality than clopidogrel . This raises concern about the current practice of substituting clopidogrel for ticlopidine after stenting and highlights the need for further long-term studies
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 .