Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients

Blacks are disproportionately affected by stroke, yet they have been underrepresented in clinical trials. Recommendations for stroke prevention in this population have been based largely on trials that have included few black participants. This may not be an optimal practice because blacks are among those with a higher prevalence of major cardiovascular risk factors, a different distribution of atherosclerotic occlusive cerebral vascular lesions, vascular biological differences such as low renin hypertension, and a different pattern of use of medical procedures and access to care that could influence outcome.

A subgroup analysis of the Ticlopidine Aspirin Stroke Study (TASS)suggested a more favorable risk-benefit profile for nonwhites than whites. Specifically, among the 495 black and 108 nonwhite and nonblack study participants, there was a 24.1% relative risk reduction (RRR) for stroke and death at 2 years favoring ticlopidine (500 mg/d) over aspirin (1300 mg/d), and 10% fewer s...