The Ticlopidine Aspirin visitation...

The Ticlopidine Aspirin visitation Study (TASS) suggested that, compared with whites, blacks might benefit preferentially from ticlopidine therapy. Given this suggestive data and the high hardship burden in blacks, Gorelick and colleagues designed the African American Antiplatelet pat Prevention Study (AAASPS) to determine the part of aspirin compared with ticlopidine in preventing returning stroke and cardiovascular events.

Patients were randomized in a 1:1 ratio to aspirin or ticlopidine with the hypothesis that, in a black population, 500 mg by day of ticlopidine would be more effective in preventing returning stroke, myocardial infarction (MI), or vascular death than 650 mg through day of aspirin. Study participants with a novel history of ischemic stroke were followed for up to pair years after randomization.

Of the 1809 participants, 902 patients were in the ticlopidine assign places to and 907 were in the aspirin assemblage Because of futility analyses suggesting a les than 1 percent chance that patients taking ticlopidine would have better consequences than patients taking aspirin, the studious mood continued to completion in unblend fashion, with patients opting to continue or respond to care in their community.

Of the 245 primary issues (the composite of recurrent pat MI, or vascular death), 133 occurr in the ticlopidine clump and 112 in the aspirin assemblage with no statistically significant difference between the pair Although a slight excess of hardships in the ticlopidine group was not statistically significant, Kaplan-Meier 1s indicated a trend toward a statistically significant difference in time to fatal or nonfatal rap favoring the aspirin group. Overall, the two-year primary circumstance rate was 19.7 percent among the patients taking ticlopidine compared with 163 percent in the patients taking aspirin.

Ticlopidine has been shown to be effective in preventing attack with a marginally significant difference in the prevention of returning stroke or death from any cause compared with aspirin. In this trial, ticlopidine did not abate the composite outcome of renewed stroke, MI, or vascular death. A sweep toward statistically significant fatal or nonfatal hit reduction favored the aspirin form into groups and analyses suggested a 40 to 50 percent likelihood that aspirin would be significantly better in preventing this consequence if the trial continued to completion. Slightly more adverse events occurred in the ticlopidine group

The authors end that aspirin is a reasonable first choice in preventing noncardioembolic shock in black patients.

Gorelick PB et al. Aspirin and ticlopidine for prevention of returning stroke in black patients. A randomized trial. JAMA June 11 2003;289:2947-57

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