Ticlopidine versus aspirin for stroke prevention: On-treatment results from the ticlopidine aspirin stroke study.
Ticlopidine is the newest antiplatelet agent that has been compared with aspirin for stroke prevention. Results from the intent-to-treat analysis of the Ticlopidine Aspirin Stroke Study, a randomized, triple-blind trial, showed ticlopidine to be more effective than aspirin for the prevention of threatened stroke. We present the on-treatment analysis from this study in 3,034 eligible patients receiving either ticlopidine (500 mg daily) or aspirin (1,300 mg daily). Follow-up was for 2-6 years. During year 1, the high-risk period for stroke in patients with threatened stroke, ticlopidine reduced the risk of stroke over aspirin by 48% (p = 0.0004: the event rates were 3.4 and 6.4, respectively). The overall risk for fatal and nonfatal stroke was 27% (95% confidence intervals were 6.6 and 42.3), less with ticlopidine than with aspirin. Ticlopidine significantly decreased the risk of fatal and nonfatal stroke in both sexes and has a different adverse effect profile than aspirin. More adverse effects, primarily diarrhea and rash, were reported with ticlopidine.