The proposal is a multi center randomized double blind trial using intention to treat analyses to test the efficacy of ticlopidine hydrochloride versus aspirin in the secondary prevention of recurrent stroke, vascular death and myocardial infarction among middle aged and elderly African American patients with non-cardioembolic ischemic stroke. The trial will also study differences in adverse experiences and the safety profile between ticlopidine and aspirin in the African American non-cardioembolic ischemic stroke patients. The trial will be conducted in teh Chicago area which has a large population of middle aged and elderly African Americans. The trial is important as African Americans suffer an excess burden of stroke risk and stroke mortality as compared to toher racial and ethnic groups in the US. African Americans and other minorities have been underrepresented in biomedical research, and there has been no large scale clinical trial that has focused primarily on secondary stroke prevention in African Americans. Preliminary data collected from nonwhite, predominantly African American patients, in the Ticlopidine Aspirin Stroke Study (TASS) suggest that ticlopidine is more effective than aspirin in the secondary prevention of stroke and death, and nonfatal and fatal stroke. The risk of serious adverse events was also low and did not differ substantially in the group receiving ticlopidine from the group treated with aspirin.
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