SMH Alibhai, MD, FRCPC
As any physician knows, stroke is a common cause of morbidity and mortality in older patients. Strokes can be divided into three major aetiological groups--haemorrhagic, thromboembolic, and lacunar. Practically speaking, if neuroimaging does not show evidence of haemorrhage, physicians will generally treat patients who present with an acute stroke (or a transient ischaemic attack (TIA), for that matter) with either antiplatelet or anticoagulant therapy. For patients with a well-documented embolic source (e.g. atrial fibrillation), warfarin is the treatment of choice. For all other patients with non-haemorrhagic stroke, the treatment is traditionally antiplatelet therapy.
However, there are several options within antiplatelet therapy. The standard drug has been acetylsalicylic acid (ASA), or aspirin. At least four large randomized controlled trials revealed Ticlopidine to be slightly more effective in reducing the incidence of strokes and TIAs than aspirin, although it was more costly and more toxic.1 However, a later meta-analysis of 145 studies suggested ticlopidine was probably as equally effective as aspirin.2 Although newer antiplatelet agents are on the horizon (e.g.
