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The Canadian American Ticlopidine Study(CATS)is randomised,double-blind, placebo-controlled trial to assess the effect of ticlopidine(250 mg twice daily)in reducing the rate of subsequent occurrence of stroke,myocardial infarction,or vascular death in patients who have had a recent thromboembolic stroke.Twenty-five centres entered 1072 patients into the study between 1 week and 4 months after their qualifying stroke.The patients were treated and followed for up to 3 years(mean 24 months).In the efficacy analysis,the event rate per year for stroke,myocardial infarction or vascular death,considered together,was 15.3%in the placebo group and 10.8%in the ticlopidine group,representing a relative risk reduction with ticlopidine of 30.2%(95%confidence interval 7.5-48.3%;p=0. 006).Ticlopidine was beneficial for both men and women(relative risk reductions 28.1%,p=0.037,and 34.2%,p=0.045,respectively).Analysis by intention-to-treat gave a smaller estimate of risk reduction(23.3%,p=0. 020)for stroke,myocardial infarction,or vascular death.Adverse experiences associated with ticlopidine included neutropenia(severe in about 1%of cases)and skin rash and diarrhoea(severe in 2%of cases each);all were reversible.This study provides evidence of a beneficial effect of ticlopidine in both men and women with a recent thromboembolic stroke. |
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