She was completely lucid during each of these episodes. She has a history of mild hypertension controlled with hydrochlorthiazide and no other medical problems. She has a family history of coronary artery disease, but no history of stroke in the family. Her cholesterol has been measured and is normal. On physical examination you find that she is in sinus rhythm, has a II out of VI systolic ejection murmur, a left carotid bruit, and a left femoral bruit.
Physical examination is otherwise normal.
You prescribe enteric-coated aspirin in a dose of 325 mg. per day, and order an electrocardiogram and an echocardiogram which are both normal. The patient returns after the investigations and reports that she has not had another episode since beginning aspirin. However, she says that she has talked about the problem with her friends, and one woman with a very similar story is taking a drug called ticlopidine. This woman's doctor claims that ticlopidine is more effective than aspirin in the prevention of strokes, and wonders why you are giving her an inferior drug. You reply that you are aware that practice guidelines issued by a reputable organisation recommend the use of aspirin for people like the patient.