Study shows stroke drug worked no better than aspirin in blacks

CHICAGO -- An expensive drug approved during the 1990s works no better than ordinary aspirin at preventing recurring strokes in blacks, a study found.

In fact, there were hints that aspirin might do a better job than ticlopidine at preventing deaths and other serious episodes, leading the researchers to recommend the old standby for blacks who have had a stroke.

"What this shows is that it's hard to beat aspirin," said lead researcher Dr. Philip Gorelick of Rush-Presbyterian-St. Luke's Medical Center in Chicago.

Whether the findings would apply to whites and other non-blacks is unclear, since none were studied. More than 100,000 Americans are believed to use ticlopidine to prevent strokes, the researchers said. While a month's supply of aspirin can cost under $10, the equivalent amount of ticlopidine can run well over $100.

The findings appear in Wednesday's Journal of the American Medical Association.

The research involved 1,809 men and women who took aspirin or ticlopidine for up to two years, the largest-ever study to address recurring strokes in blacks, said Columbia University stroke expert Dr. Ralph Sacco, who was not involved.

Double the risks

An estimated 700,000 Americans suffer strokes each year. Blacks face almost double the risk of first-time strokes and in most age groups are more likely than whites to die of strokes.

Possible reasons include socioeconomic, cultural and genetic factors. Blacks also have a higher incidence of ailments that increase the risk of a stroke, including high blood pressure and diabetes.

Ticlopidine, sold as Ticlid, had been expected to outperform aspirin. An earlier, smaller study suggested that Ticlid was superior to aspirin in both whites and blacks, and that blacks fared better than whites.

Sacco called the latest findings surprising and said they "will limit our use of this agent."

Ticlopidine was approved in 1991 to help prevent strokes. It since has been linked to potentially serious blood disorders and is recommended only for patients who cannot take aspirin, said Pamela Van Houten, a spokeswoman for Ticlid maker Roche Laboratories.

She said the study results had been expected.

Like aspirin, ticlopidine helps make blood components called platelets less sticky and less likely to form clots.

The study was halted last year, a year early, when it became apparent that ticlopidine patients were faring no better than the aspirin group.

A total of 133 recurrent strokes, heart attacks or vascular-related deaths occurred in the ticlopidine group, compared with 112 in the aspirin patients. The difference was not statistically significant.

There also were slightly more serious side effects in the ticlopidine group, including one possible case of a potentially deadly blood disease called thrombotic thrombocytopenic purpura. Aspirin patients had slightly more cases of gastrointestinal bleeding, but neither of these results was statistically significant.

Study participants took either 650 milligrams daily of aspirin or 500 milligrams daily of ticlopidine.

Sacco said the findings "help substantiate that cheap and widely accessible agents such as aspirin can make a difference."

The study was funded by the National Institute of Neurological Disorders and Stroke.

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