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Aspirin is at least as good as, and perhaps superior to, ticlopidine in preventing major cardiovascular events in African American survivors of ischemic stroke, That, according to a study of 1,800 patients presented at the 28th International Stroke Conference.
An interim analysis found a less than 1% chance that the antiplatelet drug ticlopidine would prove to be better than aspirin at reducing the risk of recurrent stroke, myocardial infarction, or death in a high-risk African American population.
When the blinded portion of the African American Antiplatelet Stroke Prevention Study (AAASPS) was halted prematurely in mid-2002, ticlopidine and aspirin did not differ significantly in terms of the primary end point of preventing stroke, MI, or death. But when the researchers looked solely at the secondary end point of fatal or nonfatal recurrent stroke, aspirin’s protective superiority did approach significance (P value of 0.083).
Almost 5 years into the trial, it became clear to biostatisticians that there was virtually no chance that ticlopidine would prevail. There was an estimated 40%-50% chance that aspirin would prove to be the more protective agent overall by the study’s scheduled conclusion in October 2003.
“Our data suggest that ticlopidine is unlikely to be superior to aspirin in preventing recurrent stroke and other major vascular events. Aspirin is inexpensive, readily available, easy to use, and relatively safe,” said DeJuran Richardson, Ph.D., a member of the preventive medicine faculty at Rush Medical College in Chicago and a study investigator. “Ticlopidine is more expensive, [is] labor intensive to use, and may have a less favorable and potentially serious adverse event profile.”
Aspirin should be considered a “reasonable initial choice” for recurrent stroke prevention in African Americans who are aspirin tolerant and who have suffered noncardioembolic, ischemic strokes, Dr. Richardson said at the conference sponsored by the American Stroke Association.