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