title: A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents.
abstract: OBJECTIVE
  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
  Randomized 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 randomly 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 infarction 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.
authors.affiliation: Bad Krozingen Heart Center, Bad Krozingen, Germany. chmueller@uhbs.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Helmut
authors.initials: H
authors.lastname: Roskamm
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Patrick
authors.initials: P
authors.lastname: Hunziker
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.forename: André
authors.initials: A
authors.lastname: Perruchoud
authors.forename: Heinz J
authors.initials: HJ
authors.lastname: Buettner
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use*; D011183:Postoperative Complications; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D013988:Ticlopidine / Q000008:administration & dosage* / Q000031:analogs & derivatives / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin