Terutroban Not Superior to Aspirin in Preventing Stroke

Stroke occurs due to decrease in blood supply to a part of the brain. Strokes that occur due to a block in the arteries supplying to the brain are referred to as ischemic strokes.  Partial block of the arteries result in Transient Ischemic Attacks (TIAs), which are mild forms of stroke.  Aspirin is widely used to prevent recurrent attacks of such strokes or of transient ischemic attacks (TIAs).  It acts as an antiplatelet agent, that is, it prevents clumping of platelets and thus prevents clots from forming and blocking the flow in blood vessels.

A recent study was conducted which compared aspirin with a new antiplatelet drug called terutroban in preventing recurrent stroke and related events.  It was hypothesized that Terutroban has antiplatelet effects as well as beneficial effects on blood vessels and could be superior to aspirin in such cases.  The results of the PERFORM study (Prevention of cerebrovascular and cardiovascular Events of ischaemic origin with teRutroban in patients with a history oF ischaemic strOke or tRansient ischaeMic attack study), were recently published. 

The study was conducted in 46 countries and included individuals of 55 years of age or older and who suffered an ischemic stroke or arterial retinal ischemic event (due to decrease in blood supply to the retina of the eye) between 48 h and 3 months before being included in the study, or a TIA in the previous 8 days.  The patients were administered either 30 mg of terutroban or 100 mg of aspirin daily. Both the tablets looked identical and neither the investigators nor the patients were aware as to which tablet the patient was taking (such a study is called a double-blind study).  The patients were followed up for a mean of 28.3 months.

The investigators found that the incidence of ischemic strokes and heart attacks were slightly higher in the terutroban group whereas other vascular deaths were slightly more in the aspirin group.  Terutroban caused inadequately controlled blood pressure, increase in cholesterol and depression as the main side effects.  Minor bleeding was observed more commonly in the terutroban group but there was no significant difference in major bleeding in the two groups.

The study concluded that terutroban did not show any superiority over aspirin in preventing ischemic events in patients who had already suffered from one earlier.

Reference: Terutroban versus aspirin in patients with cerebral ischaemic events (PERFORM): a randomised, double-blind, parallel-group trial.  The Lancet May 25, 2011. doi:10.1016/S0140-6736(11)60600-4.

Source-Medindia