Comparison of Triflusal and Aspirin for Prevention of Vascular Events in Patients After Cerebral Infarction

Abstract

MD; for the TACIP InvestigatorsBackground and Purpose-The efficacy of the antiplatelet agent triflusal for prevention of vascular events after stroke has been reported in a pilot study. However, there is a need to confirm those results in a larger study. Methods-We performed a randomized, double-blind, multicenter study to test the efficacy of triflusal (600 mg/d) versus aspirin (325 mg/d) for prevention of vascular events in patients with stroke or transient ischemic attack (Triflusal versus Aspirin in Cerebral Infarction Prevention [TACIP]). We assessed a combined end point (incidence of nonfatal ischemic stroke, nonfatal acute myocardial infarction, or vascular death) as well as the incidence of these events separately and the incidence of major hemorrhage. Results-Of 2113 patients, 1058 received triflusal and 1055 aspirin. The mean follow-up period was 30.1 months. The incidence of combined end point (13.1% for triflusal, 12.4% for aspirin) as well the survival analysis (hazard ratio [HR] for triflusal versus aspirin, 1.09; 95% CI, 0.85 to 1.38) showed no differences between groups. The incidence of nonfatal stroke (HR, 1.09; 95% CI, 0.82 to 1.44), nonfatal acute myocardial infarction (HR, 0.95; 95% CI, 0.46 to 1.98,) and vascular death (HR, 1.22; 95% CI, 0.75 to 1.96) was also similar. A significantly higher incidence of major hemorrhages in the aspirin group was recorded (HR, 0.48; 95% CI, 0.28 to 0.82). The overall incidence of hemorrhage was significantly lower in the triflusal group (16.7% versus 25.2%) (odds ratio, 0.76; 95% CI, 0.67 to 0.86; PϽ0.001). Conclusions-This study failed to show significantly superior efficacy of triflusal over aspirin in the long-term prevention of vascular events after stroke, but triflusal was associated with a significantly lower rate of hemorrhagic complications.

Triflusal: An Antiplatelet Drug with a Neuroprotective Effect?

“…Moreover, patients treated with triflusal had a lower risk of hemorrhage than those treated with ASA (14,15,42,46). Triflusal was associated with significantly fewer episodes of cerebral hemorrhage (0.3% in patients treated with triflusal vs. 1.0% in patients treated with ASA), and the reduction was also evident in patients who received fibrinolytic therapy (14).…”

“…In long-term studies the efficacy of triflusal was similar to that of ASA, but the former led to fewer bleeding complications (see below) (15,42). Triflusal can be, therefore, considered the antiplatelet drug of choice or an alternative to ASA.…”

“…A number of recent experimental and clinical studies have shown that triflusal is a potentially useful choice in the treatment and prophylaxis of brain ischemia because of its antithrombogenic as well as neuroprotective effects. Its antithrombogenic properties have been demonstrated clinically and experimentally, while its neuroprotective effects have been shown only in animal models (1)(2)(3)33,34,42). In this article we review the most important features of triflusal, with particular attention to its effect on brain ischemia.…”

Oral Antiplatelet Therapy in Stroke Prevention. Minireview

“…40 ), a multicentric pilot study, including 431 patients, and Triflusal Aspirin Cerebral Infarction Prevention (TACIP) (ref. 41 ), including 2113 patients. In both studies, the effect of TRIF 600 mg a day and ASA 325 mg a day was compared.…”

“…However, a significant decrease in total incidence of extra-and intracranial hemorrhages was observed in the TACIP study (16.4% in TRIF vs. 24.5% in ASA) (ref. 41 ). Similar findings were also observed in the TAPIRSS study -no differences were found in the primary endpoint that combined the incidence of vascular death, cerebral ischemic infarction, nonfatal MI, or major hemorrhage (13.9% in ASA vs. 12.7% in TRIF).…”