Preliminary experience using ticlopidine in clinical practice

Although shown to be more effective than aspirin for secondary stroke prevention, the guidelines for utilizing ticlopidine in daily clinical practice are as yet undefined. We reviewed all entries into the Saint Louis University Stroke Registry for the period of January to December 1992 and identified individuals admitted with diagnosis of cerebral infarction or transient ischemic attack (TIA) and who, upon discharge, were prescribed ticlopidine. The etiologic diagnosis, event recurrence during follow-up, compliance with medication, and side effects of all these patients were documented following review of inpatient and outpatient records. A total of 32 patients, 19 (69%) with cerebral infarction and 10 (31%) with TIA were identified. The etiologic diagnoses included: 11 patients with atherothrom-boembolic events, three with lacunar strokes, seven with cardioembolic events, and 11 with stroke of uncertain etiology. None of the patients reported recurrent cerebrovascular events. Sixteen (50%) patients continued to take the drug up to their last visit, whereas 9 (28%) had it discontinued. Five patients were lost to follow-up, and two died from cardiac arrest. The reasons for drug discontinuation included high cost in two patients, allergic reactions in two, and gastrointestinal side effects in three. Two additional patients stopped taking ticlopidine on their own due to uncertain reasons. In spite of its potential usefulness, intolerance to ticlopidine and its high cost result in treatment discontinuation in a significant proportion of patients. These factors and their effect on patients' compliance must be taken into account when prescribing this medication.