{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:18:40Z","timestamp":1768321120606,"version":"3.49.0"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2000,7]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014Aspirin is the most widely studied and prescribed antiplatelet drug for patients at high risk of vascular disease. We aimed to establish how the thienopyridines (ticlopidine and clopidogrel) compare with aspirin in terms of effectiveness and safety.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014We did a systematic review of all unconfounded randomized trials comparing either ticlopidine or clopidogrel with aspirin for patients at high risk of vascular disease. The primary outcome was vascular events (stroke, myocardial infarction, or vascular death). Adverse outcomes were intracranial and extracranial hemorrhage, upper and lower gastrointestinal disturbances, neutropenia, thrombocytopenia, and skin rash.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014In 4 trials among 22 656 patients (including 9840 presenting with a transient ischemic attack\/ischemic stroke), the thienopyridines reduced the odds of a vascular event by 9% (odds ratio 0.91, 95% CI 0.84 to 0.98; 2\n            <jats:italic>P<\/jats:italic>\n            =0.01), preventing 11 (95% CI 2 to 19) events per 1000 patients treated for \u22482 years. The thienopyridines produced significantly less gastrointestinal hemorrhage and upper gastrointestinal upset (indigestion\/nausea\/vomiting) than did aspirin. Both thienopyridines increased the odds of skin rash and of diarrhea (ticlopidine by \u22482-fold and clopidogrel by approximately one third). Only ticlopidine increased the odds of neutropenia.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014The thienopyridines appear modestly more effective than aspirin in preventing serious vascular events in high-risk patients. Clopidogrel appears to be safer than ticlopidine and as safe as aspirin, making it an appropriate, but more expensive, alternative antiplatelet drug for patients unable to tolerate aspirin. However, there is insufficient information to determine which particular types of patients would benefit most, and which least, from clopidogrel instead of aspirin.\n          <\/jats:p>","DOI":"10.1161\/01.str.31.7.1779","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:10:52Z","timestamp":1308341452000},"page":"1779-1784","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":107,"title":["Thienopyridines or Aspirin to Prevent Stroke and Other Serious Vascular Events in Patients at High Risk of Vascular Disease?"],"prefix":"10.1161","volume":"31","author":[{"given":"Graeme J.","family":"Hankey","sequence":"first","affiliation":[{"name":"From the Department of Medicine (G.J.H.), University of Western Australia, Perth, Australia; Clinical Trial Service Unit (C.L.M.S.), University of Oxford, Oxford, UK; and the University of Tasmania (D.W.D.), Tasmania, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathie L. M.","family":"Sudlow","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (G.J.H.), University of Western Australia, Perth, Australia; Clinical Trial Service Unit (C.L.M.S.), University of Oxford, Oxford, UK; and the University of Tasmania (D.W.D.), Tasmania, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Dunbabin","sequence":"additional","affiliation":[{"name":"From the Department of Medicine (G.J.H.), University of Western Australia, Perth, Australia; Clinical Trial Service Unit (C.L.M.S.), University of Oxford, Oxford, UK; and the University of Tasmania (D.W.D.), Tasmania, Australia."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6921.81"},{"key":"e_1_3_2_2_2","first-page":"1333","volume":"348","year":"1996","unstructured":"CAPRIE Steering Committee. A randomised blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1333\u20131338.","journal-title":"Lancet"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Hankey GJ Sudlow CLM Dunbabin DW. Thienopyridine Derivatives (Ticlopidine Clopidogrel) Versus Aspirin in Preventing Stroke and Other Serious Vascular Events in High Vascular Risk Patients. Oxford UK: The Cochrane Library; Issue 1 2000. Update software.","DOI":"10.1002\/14651858.CD001246"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine1962.26.117"},{"key":"e_1_3_2_5_2","unstructured":"Schoop W. Open randomised study comparing ticlopidine with acetylsalicylic acid in the prevention of contralateral thrombosis in patients initially presenting with unilateral thrombosis. Guildford UK: Sanofi Winthrop; 1983. Sanofi internal report 001.6.174."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198908243210804"},{"key":"e_1_3_2_7_2","unstructured":"Sudlow C Baigent C. Antiplatelet Treatment (Secondary Prevention of Stroke and Secondary Prevention of Ischaemic Cardiac Events). In: Godlee F Goldman D eds. Clinical Evidence (Issue 3). London UK: BMJ Publishing Group and the American College of Physicians American Society of Internal Medicine; 2000."},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"Moloney BA. An analysis of the side effects of ticlopidine. In: Hass WK Easton JD eds. Ticlopidine Platelets and Vascular Disease. New York NY: Springer; 1993:117\u2013139.","DOI":"10.1007\/978-1-4613-8306-2_9"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.9.806"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.2830500203"},{"key":"e_1_3_2_11_2","unstructured":"Bertrand ME Rupprecht H-J Urban P Gerschlick AH. Comparative safety of ticlopidine and clopidogrel in coronary stent patients: data from CLASSICS. Circulation. 1999;100(suppl I):I-620. Abstract."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)03581-3"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)60237-1"}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.STR.31.7.1779","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T22:36:20Z","timestamp":1715553380000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.STR.31.7.1779"}},"subtitle":["A Systematic Review of the Evidence From Randomized Trials"],"short-title":[],"issued":{"date-parts":[[2000,7]]},"references-count":13,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2000,7]]}},"alternative-id":["10.1161\/01.STR.31.7.1779"],"URL":"https:\/\/doi.org\/10.1161\/01.str.31.7.1779","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,7]]},"assertion":[{"value":"2000-03-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2000-04-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2000-07-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}