Discussions that mention ticlopidine

Heart Disorders board

I received 2 Taxus stents in August of 2005, and 2 Cypher stents 7 weeks ago. As far as I know, these are the only 2 brands of stents approved by the FDA, for use in the US. Both manufacturers, Boston Scientific (Taxus) and Johnson & Johnson (Cypher) recommend taking Plavix and aspirin for 1 full year, after receiving a stent. My doctor and other cardiologists, that I have seen in 2 different hospitals, have prescribed this for my follow up medicinal regime. This is a standard within the US, and probably around the world, and is more than likely due to the findings of the CURE trial and the CAPRIE trial.

I cannot tolerate aspirin or any NSAID, because I abused the drugs for many years. They produced ulcers in my small intestine, and erosions in my stomach and esophagus. They are cured, but 1 aspirin can cause me lots of pain 2-3 days. My cardiologist says not to take aspirin, due to possible intestinal bleeding, in people like myself. I have taken Plavix since a stroke and heart attack 3 years ago. I haven't noticed any side effects.

So people like myself have to have protection. Plavix is better than it's competitor, so I lovingly take it without fail for stroke and post stent thrombosis prevention.

Here are some excerpts taken from the respective trials and published by the National Institutes of Health (NIH) :

A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events.

BACKGROUND: Many clinical trials have evaluated the benefit of long-term use of antiplatelet drugs in reducing the risk of clinical thrombotic events. Aspirin and ticlopidine have been shown to be effective, but both have potentially serious adverse effects. Clopidogrel (Plavix), a new thienopyridine derivative similar to ticlopidine, is an inhibitor of platelet aggregation induced by adenosine diphosphate.

METHODS: CAPRIE was a randomised, blinded, international trial designed to assess the relative efficacy of clopidogrel (75 mg once daily) and aspirin (325 mg once daily) in reducing the risk of a composite outcome cluster of ischaemic stroke, myocardial infarction, or vascular death; their relative safety was also assessed. The population studied comprised subgroups of patients with atherosclerotic vascular disease manifested as either recent ischaemic stroke, recent myocardial infarction, or symptomatic peripheral arterial disease. Patients were followed for 1 to 3 years. FINDINGS: 19,185 patients, with more than 6300 in each of the clinical subgroups, were recruited over 3 years, with a mean follow-up of 1.91 years. There were 1960 first events included in the outcome cluster on which an intention-to-treat analysis showed that patients treated with clopidogrel had an annual 5.32% risk of ischaemic stroke, myocardial infarction, or vascular death compared with 5.83% with aspirin. These rates reflect a statistically significant (p = 0.043) relative-risk reduction of 8.7% in favour of clopidogrel (95% Cl 0.3-16.5). Corresponding on-treatment analysis yielded a relative-risk reduction of 9.4%. There were no major differences in terms of safety. Reported adverse experiences in the clopidogrel and aspirin groups judged to be severe included rash (0.26% vs 0.10%), diarrhoea (0.23% vs 0.11%), upper gastrointestinal discomfort (0.97% vs 1.22%), intracranial haemorrhage (0.33% vs 0.47%), and gastrointestinal haemorrhage (0.52% vs 0.72%), respectively. There were ten (0.10%) patients in the clopidogrel group with significant reductions in neutrophils (< 1.2 x 10(9)/L) and 16 (0.17%) in the aspirin group.

INTERPRETATION: Long-term administration of clopidogrel to patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of ischaemic stroke, myocardial infarction, or vascular death. The overall safety profile of clopidogrel is at least as good as that of medium-dose aspirin.

*Note that aspirin caused intracranial haemorrhage in .47% vs Plavix .33% of patients, and gastrointestinal haemorrhage .72% vs Plavix.52%
*Neutrophils squeeze through the capillary walls and into infected tissue where they kill the invaders (e.g., bacteria). Aspirin decreased these white blood cell components in .17%, compared to .10% of the patients who took Plavix.

CURE Trial
Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.

BACKGROUND: Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI.

Long-term administration of clopidogrel after PCI was associated with a lower rate of cardiovascular death, myocardial infarction, or any revascularisation, and of cardiovascular death or myocardial infarction.

At follow-up, there was no significant difference in major bleeding between the groups.

INTERPRETATION: In patients with acute coronary syndrome receiving aspirin, a strategy of clopidogrel pretreatment followed by long-term therapy is beneficial in reducing major cardiovascular events, compared with placebo.

*Acute coronary syndrome is an umbrella term used to cover any group of clinical symptoms compatible with acute myocardial ischemia.