In the new Italian drug reimbursement scheme, aspirin is completely reimbursed, while ticlopidine is only 50% reimbursed, and only for patients with a documented allergy to aspirin. This situation has been recently criticized by a group of well known haematologists, who claim that, on the basis of the available evidence, ticlopidine should be considered a more effective prophylactic agent than aspirin after ischemic stroke (Tass study) and in patients with intermittent claudication (Stims study). They also maintain that ticlopidine should be considered first choice for patients with peptic ulcer. These assumptions are disputed in this article. First, the results of the Antiplatelet Trialists' Collaboration meta-analysis are considered, to conclude that no antiplatelet agent has been consistently shown to be more effective than aspirin. Then, attention is given to some incoherences of the Tass study (ticlopidine reduced only non cardiovascular deaths) and of the Stims study (no advantage of ticlopidine over placebo in terms of cerebrovascular events). Lastly, the results of the Tass study are used again to remind that ticlopidine determined more adverse events and drop-outs than aspirin. The higher safety of ticlopidine on the stomach (33% of gastric side effects vs 40% for aspirin) should be read bearing in mind that aspirin was used at a dose (1,300 mg daily) much higher than currently prescribed.
|Translated title of the contribution||Ticlopidine vs aspirin as an antiplatelet agent|
|Number of pages||5|
|Journal||Ricerca e Pratica|
|Publication status||Published - 1995|
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