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(Stroke. 2002;33:2138.)
© 2002 American Heart Association, Inc.

Controversies in Stroke

Aspirin Therapy Should Be First-Line Treatment in Secondary Prevention of Stroke—Against

Hans-Christoph Diener, MD

From the Department of Neurology, University Essen, Essen, Germany.

Correspondence to Dr Hans-Christoph Diener, Department of Neurology, University Essen, Hufelandstrasse 55, 45122 Essen, Germany. E-mail h.diener@uni-essen.de

Key Words: aspirin • clopidogrel • dipyridamole • stroke prevention • ticlopidine

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Patients with transient ischemic attack (TIA) are at high risk for an ischemic stroke,¹ and patients who have already suffered a stroke are at high risk for stroke recurrence. Aspirin leads only to a modest reduction both in the risk of stroke (23%) and in reducing the combined end point of stroke, myocardial infection (MI), or vascular death (18%).²

Ticlopidine is more effective than aspirin. A large multicenter trial compared a daily dose of 500 mg ticlopidine and 1300 mg/d aspirin in 3069 patients with TIA or minor stroke.³ This study was associated with a statistically significant 21% reduction (P=0.024) in fatal or nonfatal stroke risk at 3 years in patients who received ticlopidine versus aspirin. The relative risk reduction of the combined outcome of stroke, MI, or vascular death was reduced by 9% in favor of ticlopidine, which was not statistically significant. Ticlopidine, however, can lead to neutropenia in up to 0.8% of patients^3,4 and therefore is no longer the drug of choice.

Clopidogrel is an antiplatelet agent that is chemically related to ticlopidine. A pivotal randomized, blinded, international trial, Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE), examined the relative safety and efficacy of daily doses of 75 mg clopidogrel versus 325 mg aspirin in nearly 20 000 patients with stroke, MI, or peripheral arterial disease.⁵ The results of the trial showed that clopidogrel was more effective than aspirin in preventing a combined end point of ischemic stroke, MI, or vascular death. The . . . [Full Text of this Article]

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