Ticlopidine: a second look. No further use in routine practice.

(1) The clinical file on ticlopidine is based mainly on a placebo-controlled trial involving patients with lower-limb arterial disease, and two large double-blind trials in the post-stroke period, in which the comparator was a placebo in one and aspirin in the other. (2) Ticlopidine proved more effective than the placebo in both indications. In secondary prevention of ischaemic stroke, ticlopidine has a moderate advantage over aspirin in terms of efficacy but carries a risk of serious adverse effects, especially haematological. (3) An indirect comparison suggests that clopidogrel, another antiplatelet drug chemically close to ticlopidine, has comparable efficacy in cardiovascular prevention and no severe adverse effects to date.