Summary
Synopsis
Ticlopidine is a thienopyridine derivative which reduces the risk of reversible ischaemia and stroke in patients who have previously experienced a cerebral ischaemic episode. In comparison with aspirin, ticlopidine produced a significant reduction in the risk of stroke in a multicentre clinical trial involving more than 3000 patients with previous transient or persistent minor ischaemia, and was superior to placebo for the prevention of stroke recurrence in more than 1000 patients who had experienced a major thrombotic stroke. The costutility ratio for ticlopidine in comparison with aspirin was estimated to be $US31 200 to 55 000 per quality-adjusted life-year gained.
Diarrhoea is the most common adverse event in ticlopidine recipients (20 to 22% incidence versus about 10% with placebo), although skin rash, nausea, dyspepsia, bleeding events, abnormal liver function and haematological disturbances were also observed in clinical trials. Severe neutropenia is the most serious event: this developed in 0.85% of patients receiving ticlopidine in 2 large clinical studies (n = 4098) but resolved after treatment withdrawal. Fatal neutropenia, although rare, has been reported in some patients receiving ticlopidine.
Thus, ticlopidine is effective in reducing the risk of recurrent cerebral ischaemia and stroke. It appears to provide a gain over aspirin for the prevention of stroke after reversible ischaemia, particularly during the first year of treatment (when the risk of stroke is greatest), although further data on its absolute relative benefit would be useful. The extent to which ticlopidine is prescribed will probably depend on individual clinicians’ perception of its risk/benefit and costeffectiveness profiles. Ticlopidine is likely to be particularly useful for stroke prophylaxis in patients who do not tolerate aspirin or who have an ischaemic episode during aspirin treatment, and for the prevention of stroke recurrence in patients who have previously experienced a major stroke.
Overview of Pharmacodynamic Properties
Ticlopidine is a thienopyridine derivative which is structurally and functionally unrelated to other platelet aggregation inhibitors. The drug has little or no antiplatelet activity in vitro and the precise source of its antiaggregatory effects in vivo remains unclear. Ex vivo inhibition of adenosine diphosphate (ADP)-induced platelet aggregation is evident 24 to 48 hours after starting multiple-dose ticlopidine treatment, reaches a peak after about 3 days to 1 week, is maintained during long term therapy and persists for several days after treatment withdrawal. Ticlopidine has a less extensive, and generally more variable, inhibitory effect against platelet aggregation induced by collagen, platelet activating factor, epinephrine (adrenaline), thrombin or arachidonic acid than against ADP-induced aggregation. Other pharmacodynamic effects of ticlopidine include a marked prolongation of bleeding time and a modest reduction in levels of plasma fibrinogen.
Ticlopidine inhibits ADP-induced platelet aggregation by a mechanism which appears to involve effects on the 2-methylthio-ADP-binding receptor and the exposure of the fibrinogen binding site of the glycoprotein Ilb/IIIa complex in the platelet membrane.
Pharmacokinetic Properties
About 80 to 90% of an oral ticlopidine dose is absorbed, with peak plasma concentrations (Cmax0.31 to 0.70 mg/L) recorded 1.7 to 2 hours after administration of a single 250mg dose to healthy volunteers. Multiple-dose administration of ticlopidine resulted in Cmax values of 0.89 to 1.42 mg/L and steady-state concendrawal trations of ticlopidine were achieved after 5 to 14 days. In elderly volunteers (mean age ≈70 years), single or multiple doses of ticlopidine 250mg produced significant increases in the area under the plasma concentration-time curve and Cmax in comparison with a control group of younger volunteers (mean age ≈29 years). Food intake increases the rate and extent of ticlopidine absorption.
Ticlopidine is extensively metabolised in the liver, with less than 1% of an oral dose being detected in urine as the unmodified parent molecule in humans. The elimination half-life (t½β) of ticlopidine ranged from about 7 to 19 hours after single-dose administration and from about 29 to 98 hours after repeated administration to healthy volunteers. The value for t½β was increased after single but not multiple doses in elderly compared with younger individuals. Approximately 60% of a radiolabelled single dose of oral ticlopidine was detected in urine, with about 25% of the label excreted in faeces, in healthy volunteers.
Clinical Efficacy
Ticlopidine in a regimen of 250mg twice daily reduces the risk of recurrent cerebral ischaemia and stroke in at-risk patients. In 1053 patients who had experienced a major thromboembolic stroke [the Canadian American Ticlopidine Study (CATS)], ticlopidine decreased risk by 30.2% relative to placebo for the composite end-point of stroke, myocardial infarction or vascular death and by 33.5% for fatal or nonfatal stroke. A similar risk reduction (38.4%) was evident according to an on-treatment (but not intent-to-treat) analysis of composite cardiovascular and cerebrovascular outcome in 687 patients with intermittent claudication resulting from occlusive artery disease.
Ticlopidine was more effective than twice-daily aspirin 650mg in preventing cerebrovascular events when given for up to 6 years in more than 3000 patients who had experienced reversible cerebral ischaemia [the Ticlopidine Aspirin Stroke Study (TASS)]. The benefit of ticlopidine compared with aspirin was most evident during the first year of treatment, with an on-treatment risk reduction for fatal or nonfatal stroke of about 48%. Approximate 3-year risk reductions for ticlopidine compared with aspirin were 12% for death and nonfatal stroke, 21% for fatal or nonfatal stroke and 15.8% for recurrent cerebral ischaemia. Ticlopidine reduced the risk of stroke-related outcomes by up to 19% in males and up to 27% in females in comparison with aspirin.
In a subgroup of 927 patients from TASS who had experienced a minor stroke prior to entry, ticlopidine recipients had risk reductions of 42% (death or nonfatal stroke) and 36% (fatal or nonfatal stroke) during the first year of treatment.
Decision-analysis modelling indicates that 5-year treatment with ticlopidine would reduce the number of lifetime strokes in 100 high-risk patients by 2 at a cost-utility ratio compared with aspirin of $US31 200 to 55 500 (1991 US dollars) per quality-adjusted life-year gained.
Tolerability
Diarrhoea was the most common adverse event (incidence of about 20 to 22%; n = 4785) in patients with previous cerebral ischaemia or intermittent claudication who were treated with ticlopidine 250mg twice daily in large, double-blind clinical trials; about 10% of placebo recipients experienced diarrhoea in comparative studies of ticlopidine. 12.5% of patients in CATS and TASS experienced diarrhoea considered to be probably related to ticlopidine treatment. Other adverse events observed in ticlopidine recipients include skin rash or other dermatological conditions, nausea, dyspepsia, bleeding events, abnormal liver function and haematological disorders. Severe neutropenia developed in 0.85% of patients treated with ticlopidine in CATS and TASS, but resolved after treatment within all individuals. Several cases of fatal neutropenia have been reported in patients receiving ticlopidine.
The total incidence of adverse events in ticlopidine recipients was 54% in CATS (compared with 34% for placebo) and 62% in TASS (compared with 53% for aspirin). For ticlopidine, rates of treatment withdrawal because of adverse events were 1.5-fold higher than for aspirin and 3 to 4 times higher than for placebo.
Dosage and Administration
The recommended dosage of ticlopidine is 250mg twice daily with food. Detailed haematological monitoring (complete blood cell count and white blood cell differential at baseline and every 2 weeks) is essential during the first 3 months of ticlopidine treatment because of the risk of neutropenia; more regular monitoring is appropriate in patients who show signs of neutropenia. Ticlopidine should be used with caution in patients with an increased risk for haemorrhagic events. Dosage reduction or discontinuation may be necessary in patients with renal impairment although data are lacking in this respect. Ticlopidine is contraindicated in patients with severe liver failure, haematopoietic or haemostatic disorders or active pathological bleeding.
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References
Ito MK, Smith AR, Lee ML. Ticlopidine: a new platelet aggregation inhibitor. Clin Pharm 1992 Jul; 11: 603–17
McTavish D, Faulds D, Goa KL. Ticlopidine: an updated review of its pharmacology and therapeutic use in platelet-dependent disorders. Drugs 1990 Aug; 40: 238–59
Feuerstein GZ, Ruffolo Jr RR. Ticlopidine: a novel antiplatelet drug for prevention of thrombotic disorders. Expert Opin Invest Drug 1994 Nov; 3(11): 1163–9
Bruno JJ, Maloney BA. Ticlopidine. In: Scriabine A, editor. New Drugs Annual. New York: Raven Press, 1983: 295–316
Saltiel E, Ward A. Ticlopidine: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in platelet-dependent disease states. Drugs 1987 Aug; 34: 222–62
Schrör K. The basic pharmacology of ticlopidine and Clopidogrel. Platelets 1993 Oct; 4: 252–61
Harker LA, Fuster V. Pharmacology of platelet inhibitors. J Am Coll Cardiol 1986 Dec; 8(6): 21B–32B
Colman RW, Walsh PN. Mechanisms of platelet aggregation. In: Colman RW, Hirsh J, Marder VJ, et al., editors. Hemostasis and Thrombosis: Basic principles and Clinical Practice. 2nd ed. Philadelphia: JB Lippincott, 1987: 594–605
Robert S, Miller AJ, Fagan SC. Ticlopidine: a new antiplatelet agent for cerebrovascular disease. Pharmacotherapy 1991; 11(4): 317–25
Defreyn G, Bernat A, Delebassee D, et al. Pharmacology of ticlopidine: a review. Semin Thromb Hemost 1989 Apr; 15(2): 159–66
Hoffman-La Roche. Ticlid® (Ticlopidine HCl) 250mg tablets bid. Product Monograph. Nutley, New Jersey, USA, 1995
Knudsen JB, Gormsen J. The effect of ticlopidine on platelet function in normal volunteers and in patients with platelet hyperaggregability in vitro. Thromb Res 1979; 16: 663–71
Ketsa-Ard K, Juengchareon M, Poungvarin N, et al. Clinical study on antithrombotic effects of ticlodipine in ischemic stroke. J Med Assoc Thai 1991 Jun; 74: 331–9
Uchiyama S, Sone R, Nagayama T, et al. Combination therapy with low-dose aspirin and ticlopidine in cerebral ischemia. Stroke 1989 Dec; 20: 1643–7
Conard J, Lecrubier C, Scarabin PY, et al. Effects of long term administration of ticlopidine on platelet function and hemostatic variables. Thromb Res 1980; 20(1): 143–8
Carrieri P, Orefice G, Fioretti A, et al. Effects of long-term ticlopidine treatment on platelet function and its tolerability in cerebrovascular disease. J Int Med Res 1984; 12: 286–91
Ikeda Y, Kikuchi M, Murakami H, et al. Comparison of the inhibitory effects of cilostazol, acetylsalicylic acid and ticlopidine on platelet functions ex vivo. Randomized, double-blind cross-over study. Arzneimittelforschung 1987 May; 37: 563–6
Cattaneo M, Akkawat B, Lecchi A, et al. Ticlopidine selectively inhibits human platelet responses to adenosine diphosphate. Thromb Haemost 1991 Dec 2; 66: 694–9
Ruan C, Destelle G, Wang Z, et al. Ticlopidine in China: comparative study on the effect of two dose levels on bleeding time and platelet function in healthy volunteers. Haemostasis 1989; 19: 94–9
Shimodaira H, Shibuya H, Uchida K, et al. Clinical study of some platelet antiaggregation agents on healthy volunteers [in Japanese]. Rinsho Yakuri 1990 Sep; 21: 605–12
Hardisty RM, Powling MJ, Nokes TJC. The action of ticlopidine on human platelets. Studies on aggregation, secretion, calcium mobilization and membrane glycoproteins. Thromb Haemost 1990 Aug 13; 64: 150–5
Harker LA. Antiplatelet drugs in the management of patients with thrombotic disorders. Semin Thromb Hemost 1986 Apr; 12(2): 134–55
Dembinska-Kiec A, Virgolini I, Rauscha F, et al. Ticlopidine and platelet function in healthy volunteers. Thromb Res 1992 Mar 1; 65(4/5): 559–70
Tohgi H, Takahashi H, Kashiwaya M, et al. Effect of plasma fibrinogen concentration on the inhibition of platelet aggregation after ticlopidine compared with aspirin. Stroke 1994 Oct; 25: 2017–21
Di Minno G, Cerbone AM, Mattioli PL, et al. Functionally thrombasthenic state in normal platelets following the administration of ticlopidine. J Clin Invest 1985 Feb; 75: 328–38
Chignard M, Lalau Keraly C, Delautier D, et al. Reduced sensitivity of human platelets to PAF-acether following ticlopidine intake. Haemostasis 1989; 19: 213–8
Lalau Keraly C, Delautier D, Delabassee D, et al. Inhibition by ticlopidine of Paf-acether-induced in vitro aggregation of rabbit and human platelets. Thromb Res 1984 Jun 15; 34: 463–71
Lecrubier C, Conard J, Horellou MH, et al. Study of platelet aggregation induced by platelet activating factor (PAF) after administration of ticlopidine or aspirin. Agents Actions 1983 Feb; 13: 77–80
David JL, Monfort F, Herion F, et al. Compared effects of three dose-levels of ticlopidine on platelet function in normal subjects. Thromb Res 1979 Jan; 14: 35–49
Cattaneo M, Akkawat B, Kinlough-Rathbone RL, et al. Ticlopidine facilitates the deaggregation of human platelets aggregated by thrombin. Thromb Haemost 1994 Jan; 71(1): 91–4
Uchiyama S, Yamazaki M, Maruyama S, et al. Shear-induced platelet aggregation in cerebral ischemia. Stroke 1994 Aug; 25: 1547–51
Cattaneo M, Lombardi R, Bettega D. Shear-induced platelet aggregation is potentiated by desmopressin and inhibited by ticlopidine. Arterioscler Thromb 1993 Mar; 13: 393–7
Hayakawa M, Kuzuya F. Effects of ticlopidine on erythrocyte aggregation in thrombotic disorders. Angiology 1991 Sep; 42: 747–53
Tanahashi N, Fukuuchi Y, Tomita M, et al. Ticlopidine improves the enhanced erythrocyte aggregability in patients with cerebral infarction. Stroke 1993 Jul; 24: 1083–6
O’Brien JR, Etherington MD, Shuttleworth RD. Ticlopidine — an antiplatelet drug: effects in human volunteers. Thromb Res 1978 Aug; 13: 245–54
Thebault JJ, Blatrix CE, Blanchard JF, et al. Effects of ticlopidine, a new platelet aggregation inhibitor in man. Clin Pharmacol Ther 1975 Oct; 18: 485–90
Panak E, Maffrand JP, Picard-Fraire C, et al. Ticlopidine: a promise for the prevention and treatment of thrombosis and its complications. Haemostasis 1983; 13 Suppl. 1: 1–54
Di Perri T, Pasini FL, Frigerio C, et al. Pharmacodynamics of ticlopidine in man in relation to plasma and blood cell concentration. Eur J Clin Pharmacol 1991 Nov; 41: 429–34
Hoffman-La Roche (Mississauga), 1995. (Data on file)
Thebault J-J, Blatrix CE, Blanchard JF, et al. The interactions of ticlopidine and aspirin in normal subjects. J Int Med Res 1977; 5: 405–11
Ciuffetti G, Aisa G, Mercuri M, et al. Effects of ticlopidine on the neurologic outcome and the hemorheologic pattern in the postacute phase of ischemic stroke: a pilot study. Angiology 1990 Jul; 41: 505–11
Boisseau MR, Mazoyer E, Ripoll L, et al. Does ticlopidine treatment lower plasma fibrinogen: a review of the literature. Clin Hemorheol 1994 Mar–Apr; 14: 171–80
Savi P, Laplace M-C, Maffrand JP, et al. Binding of [3H]-2-methylthio ADP to rat platelets — effect of Clopidogrel and ticlopidine. J Pharmacol Exp Ther 1994 May; 269: 772–7
Defreyn G, Gachet C, Savi P, et al. Ticlopidine and clopidogrel (SR 25990C) selectively neutralize ADP inhibition of PGE1-activated platelet adenylate cyclase in rats and rabbits. Thromb Haemost 1991 Feb 12; 65: 186–90
Cahill M, Mistry R, Barnett DB. The human platelet fibrinogen receptor: clinical and therapeutic significance. Br J Clin Pharmacol 1992 Jan; 33: 3–9
Desager JP, van Nieuwenhuyze Y, Dricot J, et al. Pharmacokinetic profile and bioavailability of a new galenic formulation of ticlopidine. Int J Clin Pharmacol Res 1990; 10(4): 247–50
Knudsen JB, Bastain W, Sefton CM, et al. Pharmacokinetics of ticlopidine during chronic oral administration to healthy volunteers and its effects on antipyrine pharmacokinetics. Xenobiotica 1992 May; 22: 579–89
Shah J, Fratis A, Ellis D, et al. Effect of food and antacid on absorption of orally administered ticlopidine hydrochloride. J Clin Pharmacol 1990 Aug; 30: 733–6
Shah J, Teitelbaum P, Molony B, et al. Single and multiple dose pharmacokinetics of ticlopidine in young and elderly subjects. Br J Clin Pharmacol 1991 Dec; 32: 761–4
Picard-Fraire C. Ticlopidine hydrochloride: relationship between dose, kinetics, plasma concentration and effect on platelet function. Thromb Res 1983 Suppl. IV: 119–28
Syntex Laboratories Inc. Ticlid® prescribing information. Palo Alto, California, 1995. In: Physicians Desk Reference, Edition 49. Montvale, New Jersey: Medical Economics Data Production Company, 1995: 2489–2492.
Syntex Laboratories Inc. Ticlid® (ticlopidine hydrochloride) tablets prescribing information. Palo Alto, California, USA, 1994
Gidal BE, Sorkness CA, McGill KA, et al. Evaluation of a potential enantioselective interaction between ticlopidine and warfarin in chronically anticoagulated patients. Ther Drug Monit 1995 Feb; 17: 33–8
Colli A, Buccino G, Cocciolo M, et al. Ticlopidine-theophylline interaction. Clin Pharmacol Ther 1987 Mar; 41: 358–62
Gent M, Blakely JA, Easton JD, et al. The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke. Lancet 1989 Jun 3; 1: 1215–20
Manopulo R, Sturani A, Insarda P. Ticlopidine in the prophylaxis of cerebral ischaemia: a trial on geriatric cases [in Italian]. Minerva Med 1988 Aug; 79: 697–8
Janzon L, Bergqvist D, Boberg J, et al. Prevention of myocardial infarction and stroke in patients with intermittent claudication; effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study. J Intern Med 1990 May; 227: 301–8
Hass WK, Easton JD, Adams Jr HP, et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med 1989 Aug 24; 321: 501–7
Harbison JW, Ticlopidine ASSG. Ticlopidine versus aspirin for the prevention of recurrent stroke. Analysis of patients with minor stroke from the Ticlopidine Aspirin Stroke Study. Stroke 1992 Dec; 23: 1723–7
Grotta JC, Norris JW, Kamm B. Prevention of stroke with ticlopidine: who benefits most? Neurology 1992 Jan; 42: 111–5
Bellavance A, Ticlopidine ASSG. Efficacy of ticlopidine and aspirin for prevention of reversible cerebrovascular ischemic events. The Ticlopidine Aspirin Stroke Study. Stroke 1993 Oct; 24: 1452–7
Weisberg LA, Ticlopidine ASSG. The efficacy and safety of ticlopidine and aspirin in non-whites: analysis of a patient subgroup from the Ticlopidine Aspirin Stroke Study. Neurology 1993 Jan; 43: 27–31
Ticlopidine Aspirin Stroke Study Group. Ticlopidine versus aspirin for stroke prevention: on-treatment results from the Ticlopidine Aspirin Stroke Study. Journal of Stroke and Cerebrovascular Disease 1993; 3: 168–76
Tohgi H, Murakami M. Pathophysiology and treatment of thrombosis. (2) The effect of ticlopidine on TIA compared with aspirin. A double-blind, 12-month and open 24-month follow-up study [in Japanese]. Nippon Naika Gakkai Zasshi 1987 Jan; 76: 49–52
Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy—I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994 Jan 8; 308: 81–106
Oster G, Huse DM, Lacey MJ. Cost-effectiveness of ticlopidine in preventing stroke in high-risk patients. Stroke 1994 Jun; 25: 1149–56
UK-TIA Study Group. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54: 1044–54
Antiplatelet Trialists’ Collaboration. Secondary prevention of vascular disease by prolonged antiplatelet treatment. BMJ 1988; 296: 320–31
Rothrock JF, Hart RG. Ticlopidine hydrochloride use and threatened stroke. West J Med 1994 Jan; 160: 43–7
Haynes RB, Sandler RS, Larson EB, et al. A critical appraisal of ticlopidine, a new antiplatelet agent. Effectiveness and clinical indications for prophylaxis of atherosclerotic events. Arch Intern Med 1992 Jul; 152: 1376–80
Ruiz-Irastorza G, Alonso JJ, Iglesias JJ, et al. Granulocyte colony-stimulating factor for neutropenia secondary to ticlopidine. Acta Haematol 1994; 91(2): 106–7
Farver DK, Hansen LA. Delayed neutropenia with ticlopidine. Ann Pharmacother 1994 Dec; 28: 1344–6
Bedani PL, Fiocchi O, Scapoli PL, et al. Leukopenia due to ticlopidine in a patient with chronic renal failure [letter]. Haematologica 1984 Sep–Oct; 69: 641–2
Martin Casellas E, Bosch Llobet A, Tous Quintana R. Severe neutropenia caused by ticlopidine (letter) [in Spanish]. Med Clin Bare 1991 Jun 8; 97: 76
Shear NH, Appel C. Prevention of ischemic stroke [letter]. N Engl J Med 1995 Aug 17; 333: 460
Carlson JA, Maesner JE. Fatal neutropenia and thrombocytopenia associated with ticlopidine. Ann Pharmacother 1994 Nov; 28: 1236–8
Guerciolini R, Giordano G, Aversa F, et al. Anaemia and agranulocytosis associated with ticlopidine therapy. Acta Haematol 1985;73: 232–4
Fernández de Sevilla T, Alegre J, Ocaña I, et al. Aplastic anemia secondary to ticlopidine (letter) [in Spanish]. Med Clin Barc 1988 Feb 20; 90: 308–9
Garnier G, Taillan B, Pesce A. Ticlopidine and severe aplastic anaemia. Br J Haematol 1992 Jul; 81: 459–60
Troussard X, Mayo P, Mosquet B. Ticlopidine and severe aplastic anaemia. Br J Haematol 1992 Dec; 82: 779–80
Mataix R, Ojeda E, Del Carmen Perez M. Ticlopidine and severe aplastic anaemia. Br J Haematol 1992 Jan; 80: 125–6
Khelif A, Assouline D, Ffrench M, et al. Ticlopidine and aplastic anaemia. Br J Haematol 1993 Apr; 83: 678–9
Martin-Nuñez G, Fdez-Soria RR, Sanchez-Gil F, et al. Aplastic anaemia and ticlopidine. Br J Haematol 1993 Nov; 85: 633
Rodriguez JN, Fernandez-Jurado A, Dieguez JC, et al. Ticlopidine and severe aplastic anemia [letter]. Am J Hematol 1994 Dec; 47: 332
Weiner P, Zidan F, Paz R. Severe aplastic anemia due to ticlopidine. Isr J Med Sci 1995 Jul; 31: 444–5
Tsatalas C, Chalkia P, Garyfallos A, et al. Ticlopidine-induced aplastic anaemia: case report and review of the literature. Clin Drug Invest 1995 Feb; 9: 127–30
Oh PI, Shear NH. Fatal aplastic anemia related to ticlopidine therapy — a model for reporting of adverse drug reactions [abstract PI-88]. Clin Pharmacol Ther 1993 Feb; 53(2): 157
Mallet L, Mallet J. Ticlopidine and fatal aplastic anemia in an elderly woman. Ann Pharmacother 1994 Oct; 28: 1169–71
Claas FHJ, de Fraiture WH, Meyboom RHB. Thrombocytopenia due to antibodies induced by ticlopidine [in French]. Nouv Rev Fr Hematol 1984; 26: 323–4
Takishita S, Kawazoe N, Yoshida T, et al. Ticlopidine and thrombocytopenia [letter]. N Engl J Med 1990 Nov 22; 323: 1487
Centurioni R, Candela M, Leoni P, et al. Is ticlopidine really responsible for thrombotic thrombocytopenic purpura? Haematologica 1993 May–Jun; 78: 196–7
Capra R, Marciano N, Fieni F, et al. Cerebral hemorrhage and thrombotic thrombocytopenic purpura during ticlopidine treatment: case report. Acta Neurol Belg 1992; 92: 83–7
Tardy B, Page Y, Tardy-Poncet B, et al. Thrombotic thrombocytopenic purpura related to ticlopidine [abstract 1393]. Thromb Haemost 1991 Jun 5; 65 Suppl.: 1082
Billard JL, Page R, Vermesch-Vergnaud R, et al. Thrombocytopenic thrombotic purpura occurring in spite of antiaggregant treatment using ticlopidine (letter) [in French]. Presse Med 1989 May 13; 18: 984
Ellie E, Durrieu C, Besse P, et al. Thrombotic thrombocytopenic purpura associated with ticlopidine. Stroke 1992 Jun; 23: 922–3
Falezza G, Girelli D, Olivieri O, et al. Thrombotic thrombocytopenic purpura developed during ticlopidine therapy [letter]. Haematologica 1992; 77: 525
Kovacs MJ, Soong PY, Chin-Yee IH. Thrombotic thrombocytopenic purpura associated with ticlopidine. Ann Pharmacother 1993 Sep; 27: 1060–1
Lombardi B, Florio S, Peluchetti D, et al. Thrombotic thrombocytemic purpura (TTP) in a patient with TIA treated with ticlopidine [abstract 337]. Thromb Haemost 1993 Jun 30; 69: 636
del Rey Moreno J, López Cortés LF, Gómez Mateos JM, et al. Agranulocytosis caused by ticlopidine (letter) [in Spanish]. Neurologia 1992 May; 7: 121–2
Legarra G, Beltrán de Heredia JM, Olabarria I, et al. Agranulocytosis caused by ticlopidine (letter) [in Spanish]. Sangre Barc 1994 Jun; 39: 229–30
Quaglino D, Venturoni L, Cretara G, et al. Reversible bone-marrow suppression primarily involving granulopoiesis following the use of ticlopidine [letter]. Haematologica 1982 Nov–Dec; 67: 940–1
Marmont AM, Lotti G, Nati S, et al. Agranulocytosis caused by ticlopidine [in Italian]. Recenti Prog Med 1985 May; 76: 245–8
Ono K, Kurohara K, Yoshihara M. Agranulocytosis caused by ticlopidine and its mechanism. Am J Hematol 1991 Aug; 37: 239–42
Elias M, Reichman N, Flatau E. Bone marrow aplasia associated with ticlopidine therapy. Am J Hematol 1993 Dec; 44: 289–90
Pioda GB, Del Favero A, Rambotti P. Bone marrow aplasia associated with ticlopidine treatment in a patient with idiopathic hypothyroidism [in Italian]. Clin Ter 1989 Sep 30; 130: 337–40
Montanari G, Mussida M, Scarabelli C, et al. Mainly neutropenic pancytopenia caused by acute bone marrow depression during ticlopidine treatment [in Italian]. Clin Ter 1987 Oct 31; 123: 111–4
de Gramont A, Canuel C, Krulik M, et al. Hematological toxicity of ticlopidine? [in French]. Nouv Rev Fr Hematol 1982; 24: 35–7
Greaney Jr JJ, Hess DA, Mahoney CD. Ticlopidine-induced cholestatic jaundice. Clin Pharm 1993 Jun; 12: 398–9
Mammarella A, Paoletti V, Moroni C, et al. Ticlopidine-induced cholestatic jaundice [in Italian]. Clin Ter 1991 Jul 15; 138: 45–6
Nurhussein MA. Ticlopidine-induced prolonged cholestasis. J Am Geriatr Soc 1993 Dec; 41: 1371–2
Sondag D, Bader R, Claude P. Ticlopidine hepatitis: a new case [in French]. Ann Gastroenterol Hepatol 1993 Jan–Feb; 29: 40–1
Yoder JD, Algozzine GJ, Hill GW. More ticlopidine-induced cholestatic jaundice. Am J Hosp Pharm 1994 Jul 15; 51: 1821–2
Weber E, Donckier J. Cholestatic jaundice associated with ticlopidine: a new case [in French]. Acta Clin Belg 1994 Dec; 49: 309–10
Grimm IS, Litynski JJ. Severe cholestasis associated with ticlopidine. Am J Gastroenterol 1994 Feb; 89: 279–80
Alvaro D, Gigliozzi A, Gaudio E, et al. Ticlopidine-induced cholestasis: report of two cases and experimental evidence of the drug’s adverse effect in isolated perfused rat liver. Eur J Gastroenterol Hepatol 1994 Oct; 6: 943–50
Colivicchi F, Magnanimi S, Sebastiani F, et al. Ticlopidine-induced chronic cholestatic hepatitis: a case report. Curr Ther Res 1994 Aug; 55: 929–31
Cassidy LJ, Schuster BG, Haiparin LS. Probable ticlopidine-induced cholestatic hepatitis. Ann Pharmacother 1995 Jan; 29: 30–2
Mirras Parra FJ, Goméz Jiménez FJ, Garcia Contreras T, et al. Hepatitis colestática por ticlopidina. Rev Esp Enferm Dig 1995; 87: 414–5
Naschitz JE, Khamessi R, Elias N, et al. Ticlopidine-induced prolonged cholestasis [letter]. J Toxicol Clin Toxicol 1995; 33(4): 379–80
Dyken ML, Wolf PA, Barnett HJM, et al. Risk factors in stroke: a statement for physicians by the Subcommittee on Risk Factors and Stroke of the Stroke Council. Stroke 1984 Nov–Dec; 15(6): 1105–11
Keyser A. Platelet aggregation inhibitors in neurology. Pharm World Sci 1993 Dec 17; 15(6): 243–51
Dennis MS, Bamford JM, Sandercock PAG, et al. Prognosis of transient ischemic attacks in the Oxfordshire Community Stroke Project. Stroke 1990; 21: 848–53
Albers GW. Antithrombotic agents in cerebral ischemia. Am J Cardiol 1995 Feb 23; 75: 34B–8
Simcock JP. Stroke and TIA. The role of anticoagulant and antiplatelet therapy. Curr Ther 1993 Feb; 34: 14–6
Bruno A. Ischemic stroke, part 2: optimal treatment and prevention. Geriatrics 1993 Mar; 48: 37–54
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Various sections of the manuscript reviewed by: G.W. Albers, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, California, USA; N. Anderson, Neurophysiology Department, Auckland Hospital, Auckland, New Zealand; M. Cattaneo, Hemophilia and Thrombosis Centre, Milan, Italy; T. Di Perri, Istituto di Clinica Medica Generale e Terapia Medica, Università degli Studi di Siena, Siena, Italy; M. Gent, Hamilton Civic Hospitals Research Centre, Hamilton, Ontario, Canada; J.C. Grotta, Department of Neurology, University of Texas Medical School, Houston, Texas, USA; G.J. Hankey, Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia; J.W. Harbison, Department of Neurology and Ophthalmology, Medical College of Virginia, Richmond, Virginia, USA; A. Harley, The Cardiothoracic Centre — Liverpool, N.H.S. Trust, Liverpool, England; R.H. Raasch, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; J.F. Rothrock, Department of Neurology, University of South Alabama, Mobile, Alabama, USA; K. Schrör, Institutes für Pharmakologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; H. Tohgi, Department of Neurology, Iwate Medical University, Morioka, Japan; S. Uchiyama, Department of Neurology, Tokyo Women’s Medical College, Tokyo, Japan; M. Verstraete, Center for Molecular and Vascular Biology, Katholieke Universiteit Leuven, Leuven, Belgium.
An erratum to this article is available at http://dx.doi.org/10.1007/BF03259714.
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Noble, S., Goa, K.L. Ticlopidine. Drugs & Aging 8, 214–232 (1996). https://doi.org/10.2165/00002512-199608030-00006
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DOI: https://doi.org/10.2165/00002512-199608030-00006