Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study.
The Swedish Ticlopidine Multicentre Study (STIMS) was a double-blind placebo-controlled trial designed to determine whether ticlopidine, a platelet antiaggregatory agent, reduces the incidence of myocardial infarction, stroke and transitory ischaemic attacks in patients with intermittent claudication. A total of 687 patients was monitored for a minimum of 5 years or until an end-point was reached. The number of end points (99 vs. 89), analysed according to the intention-to-treat principle, was 11.4% lower in the ticlopidine group (P = 0.24). The mortality rate was 29.1% lower in the ticlopidine group (64 vs. 89, P = 0.015); this observation could be accounted for by a reduced mortality from ischaemic heart disease. On-treatment analysis showed there to be significantly fewer end points in the ticlopidine group (47 vs. 76, P = 0.017). Diarrhoea was the most common side-effect. Reversible leucopenia or thrombocytopenia was reported in seven patients on ticlopidine. It is concluded that the high morbidity and mortality from cardio- and cerebrovascular disease in patients with intermittent claudication can be reduced by long-term treatment with ticlopidine.
Department of Surgery, Malmö General Hospital, Sweden.
L
L
Janzon
D
D
Bergqvist
J
J
Boberg
M
M
Boberg
I
I
Eriksson
F
F
Lindgärde
G
G
Persson
B
B
Almgren
B
B
Fagher
T
T
Kjellström
D000368:Aged; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000517:prevention & control*; D003327:Coronary Disease / Q000401:mortality; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy*; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D013988:Ticlopidine / Q000009:adverse effects / Q000627:therapeutic use*
D013988:Ticlopidine