Ticlopidine is a thienopyridine-derivative platelet antiaggregant that acts primarily by inhibiting the adenosine diphosphate pathway of the platelet membrane. In the treatment of cerebrovascular disease, ticlopidine is indicated to reduce the risk of atherothrombotic stroke in patients who have experienced TIAs and in patients who have had a completed ischemic stroke. I reserve the use of ticlopidine for patients who are intolerant to aspirin therapy because of side effects. The dose used is 250 mg twice daily given orally. I use ticlopidine 250 mg daily for 1 week, and 250 mg twice daily thereafter.
Severe neutropenia is the most serious event in ticlopidine-treated patients.
Patients taking ticlopidine must have complete blood counts and platelet counts every 2 weeks for the first 3 months. Using intravenous unfractionated heparin for the treatment of acute ischemic stroke has been a topic of continuing debate. I also use intravenous heparin in patients with recent unquestionable nonseptic cardioembolic cerebral infarction in an attempt to prevent recurrence. When I use intravenous heparin, I do not use a bolus, and I aim for a target activated partial thromboplastin time of 55 to 75 seconds, or 1.5 to 2 times control. However, treatment did not reduce the death rates.