NEUROLOGY 1992;42:111
© 1992 American Academy of Neurology
Prevention of stroke with ticlopidine
Who benefits most?
J. C. Grotta, MD,
J. W. Norris, MD,
B. Kamm, MA and
TASS Baseline and Angiographic Data Subgroup
From the Department of Neurology (Dr. Grotta), University of Texas Medical School, Houston, TX; Department of Neurology (Dr. Norris), University of Toronto, Toronto, ON, Canada; and Syntex Research (B. Kamm), Palo Alto, CA.
* Members of the Tass Baseline and Angiographic Data Subgroup: H.P. Adams, Iowa City, IA; B.A. Anderson, Winnipeg, MB, Canada; A. Bellavance, St. Lambert, PQ, Canada; J.A. Byer, Columbia, MO; J.R. Couch, Springfield, IL; B.H. Dobkin, Los Angeles, CA; M.J. Fisher, Los Angeles, CA; G.R. Hanna, Charlottesville, VA; L.A. Hershey, Cleveland, OH; C.S. Kase, Boston, MA; J.R. Lacy, Palo Alto, CA; L.L. Levy, West Haven, CT; C. Mayman, Boston, MA; J.S. Meyer, Houston, TX; C.P. Olinger, Cincinnati, OH; W. Pryse-Phillips, St. Johns, NF, Canada; J.T. Robertson, Memphis, TN; J.F. Rothrock, San Diego, CA; C.H. Sadowsky, Palm Beach, FL; P.D. Swanson, Seattle, WA; J. Taylor, Richmond, VA; and L.A. Weisberg, New Orleans, LA.
We examined the baseline characteristics of patients in the Ticlopidine Aspirin Stroke Study (TASS) to determine if the effects of the two treatments in preventing stroke differed in various subgroups. Patients with the following characteristics did less well on aspirin: elevated creatinine, hypertension or diabetes requiring treatment, or treatment with anticoagulant or antiplatelet drugs prior to their qualifying TIA or stroke. Women and patients with vertebrobasilar symptoms did particularly well on ticlopidine. We performed arteriography in 1,188 patients with carotid qualifying events. The frequency of stroke in patients with abnormal arteriograms ipsilateral to their symptoms was slightly higher than in those with normal carotid arteries. Ticlopidine was more effective in patients without carotid stenosis. Ticlopidine is more effective than aspirin in preventing strokes in patients having warning TIAs. The patients who benefit most from ticlopidine may be women, those who have vertebrobasilar symptoms, those with cerebral ischemic symptoms while on aspirin or anticoagulant therapy, and patients with diffuse atherosclerotic disease rather than high-grade carotid stenosis.
Address correspondence and reprint requests to Dr. James C. Grotta, University of Texas Medical School, Department of Neurology, 6431 Fannin, MSB 7.044, Houston, TX 77030.
Received April 16, 1991. Accepted for publication in final form July 1, 1991.
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