A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of...

Area of Science:

• Cardiology
• Pharmacology
• Interventional Cardiology

Background:

• Ticlopidine and aspirin effectively reduce thrombotic stent occlusions (TSO) and bleeding after coronary stenting.
• Ticlopidine use is limited by adverse hematological and gastrointestinal effects.
• The safety and efficacy of clopidogrel post-stenting require further evaluation.

Purpose of the Study:

• To compare the safety and efficacy of clopidogrel versus ticlopidine as antiplatelet therapy after coronary artery stenting.
• To assess the rates of cardiac and noncardiac events in patients receiving either clopidogrel or ticlopidine with aspirin.

Main Methods:

• A randomized trial involving 700 patients (899 lesions) undergoing coronary stenting.
• Patients received either 500 mg ticlopidine or 75 mg clopidogrel, plus 100 mg aspirin for 4 weeks.
• Primary endpoints included cardiac events (death, revascularization, TSO, MI) and noncardiac events (death, stroke, bleeding).

Main Results:

• Cardiac events occurred in 3.1% of clopidogrel patients and 1.7% of ticlopidine patients (P=0.24).
• Noncardiac events were significantly lower in the clopidogrel group (4.5%) compared to the ticlopidine group (9.6%) (P=0.01).

Conclusions:

• Aspirin plus clopidogrel is a safe and effective antiplatelet regimen post-coronary stenting, comparable to aspirin plus ticlopidine.
• Clopidogrel significantly reduced noncardiac adverse events compared to ticlopidine.