Prevention

Alternatives include ticlopidine ^a

Why?

• Ticlopidine reduces recurrent stroke, myocardial infarction and vascular death. ^a
• It is more effective than aspirin at reducing stroke, though there is no clear difference in mortality. ^a
• However adverse effects severe enough to discontinue therapy are common (particularly neutropenia) ^a

Ticlopidine reduces recurrent stroke, MI and vascular death

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
recent thromboembolic stroke a	ticlopidine	placebo	stroke, MI or vascular death at 3 years	25%	2.0% (0.0% to 36%)	19 (10 to 760)
			discontinued therapy due to adverse effects at 3 years	2.8%	-320% (-620% to -140%)	-11 (-17 to -8)
recent TIA or minor stroke a	ticlopidine	aspirin	stroke at 3 years	14%	18% (1% to 32%)	40 (21 to 560)
			adverse effect at 3 years	53%	-17% (-10% to -24%)	-11 (-18 to -8)