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Efficacy of combination antiplatelet therapy and nicardipine for chronic cerebral infarction
1Department of Internal Medicine, Shin-Kokura Hospital, Kitakyushu, Japan.
Insights
Combining nicardipine hydrochloride with aspirin effectively prevents cerebral infarction (CI) recurrence by significantly suppressing platelet aggregation. This combination therapy offers a promising alternative for patients at risk of recurrent CI.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Recurrent cerebral infarction (CI) poses a significant health challenge.
- Antiplatelet therapy is a cornerstone in preventing CI recurrence.
- The role of calcium antagonists in conjunction with antiplatelet agents requires further elucidation.
Purpose of the Study:
- To evaluate the efficacy of combining antiplatelet therapy with a calcium antagonist for preventing recurrent cerebral infarction.
- To compare the effects of different antiplatelet agents (ticlopidine and aspirin) alone and in combination with nicardipine hydrochloride on platelet aggregation.
Main Methods:
- A randomized 8-week study involving 57 chronic CI patients.
- Four treatment groups: Ticlopidine + Nicardipine, Ticlopidine alone, Aspirin + Nicardipine, Aspirin alone.
- Platelet aggregation measured using adenosine diphosphate (ADP) and collagen, before and during therapy.
Main Results:
- Significant suppression of platelet aggregation with 2.0 microM ADP and collagen was observed in all groups.
- Groups A (Ticlopidine + Nicardipine) and B (Ticlopidine) showed significant suppression at 0.5 microM ADP.
- Group C (Aspirin + Nicardipine) demonstrated significantly greater suppression of 2-microM ADP and collagen aggregation compared to Group D (Aspirin alone).
Conclusions:
- Nicardipine hydrochloride in combination with aspirin may serve as a valuable alternative therapy for preventing recurrent cerebral infarction.
- Combination therapy, particularly Aspirin with Nicardipine, showed enhanced antiplatelet effects compared to aspirin monotherapy.
- Further research into combination therapies could optimize strategies for CI recurrence prevention.
Abstract:
To prevent recurrence of cerebral infarction (CI), the efficacy of antiplatelet therapy, when used in combination with a calcium antagonist, was examined. The study subjects were 57 chronic CI patients (40 men, 17 women; mean age, 68.5 years) who experienced either CI or its recurrence more than 3 months before the start of the study. They were randomly allocated into one of the following four groups for the 8-week study; group A--ticlopidine hydrochloride 200 mg once daily and nicardipine hydrochloride 20 mg three times daily (TID); group B--ticlopidine hydrochloride 200 mg once daily; group C--aspirin 81 mg once daily and nicardipine hydrochloride 20 mg TID; or group D--aspirin 81 mg once daily. Platelet aggregation was measured before treatment and 4 and 8 weeks after the initiation of each therapy by using adenosine diphosphate (ADP) (2 microM and 0.5 microM) and collagen (2 micrograms/mL), and evaluated in terms of percent maximum platelet aggregation. Results showed significant suppression of 2.0 microM ADP platelet aggregation in groups A, B, and C. At 0.5-microM ADP, only groups A and B showed significant platelet aggregation suppression. All groups showed significant suppression of collagen platelet aggregation. In comparing single therapy with combination therapy, groups A and B were not significantly different from one another after 4 or 8 weeks in 2-microM ADP or collagen platelet aggregation suppression. In contrast, group C had significantly greater suppression of both 2-microM ADP and collagen aggregations compared with group D. In conclusion, nicardipine hydrochloride administration with aspirin may be a useful alternative therapy for the prevention of CI recurrence.