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The thienopyridines ticlopidine and clopidogrel are alternatives for secondary prevention in patients who do not respond to or cannot take aspirin. They are no more effective than aspirin and have been associated with thrombotic thrombocytopenic purpura. The combination of aspirin and extended\u2010release dipyridamole has several mechanisms of action and an additive effect on reducing stroke risk compared with either agent alone. 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