Ticlopidine: A New Drug to Prevent Stroke

Two papers describing stroke prevention trials in more than 4000 patients of the drug ticlopidine hydrochloride appeared in 1989.1,2 There was unequivocal evidence in one of a reduction of risk of the composite end point: stroke, myocardial infarction, and vascular death in patients after ischemic stroke. In the other, significant reduction of the risk of nonfatal stroke and death in patients with transient ischemic attacks (TIA), transient monocular blindness, or minor stroke was seen when ticlopidine was compared in a “horse race” to aspirin. Since ticlopidine, previously a little known drug, has proved effective in large and carefully structured clinical trials, 3 a close examination of its origin, pharmacological characteristics, and clinical safety is indicated.