Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-21T17:00:58.124Z Has data issue: false hasContentIssue false
  • English
  • Français

Triflusal versus Aspirin for the Prevention of Stroke

Published online by Cambridge University Press:  18 December 2007

Antonio Culebras ,
Javier Borja  and
Julián García-Rafanell
Antonio Culebras
Affiliation:
Department of Neurology, Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA; Email: aculebras@aol.com
Javier Borja
Affiliation:
Drug Safety Manager, J. Uriach y Compañía, S.A., Polígon Industrial Riera de Caldes, Avinguda Camí Reial, 51–57, 08184 Palau-solità i Plegamans, Barcelona, Spain; Email: fv-borja@uriach.com
Julián García-Rafanell
Affiliation:
Director of Medical Affairs, J. Uriach y Compañía, S.A., Polígon Industrial Riera de Caldes, Avinguda Camí Reial, 51–57, 08184 Palau-solità i Plegamans, Barcelona, Spain; Email: garcia-rafanell@uriach.com
Get access Rights & Permissions [Opens in a new window]

Extract

ABSTRACT

Antiplatelet agents represent an important part of the therapeutic armamentarium in the prevention of stroke. Triflusal is an antiplatelet agent structurally related to salicylates but not derived from acetylsalicylic acid. Like aspirin, triflusal irreversibly acetylates cyclo-oxygenase isoform 1 (COX-1) and therefore inhibits thromboxane biosynthesis. Triflusal is rapidly absorbed after oral administration, with an absorption half life of 0.44 hours. Evidence of the efficacy and safety of triflusal is derived from clinical trials performed in patients with unstable angina, acute myocardial infarction, stroke, aortocoronary by-pass, atrial fibrillation, valve replacement, and asthmatic patients intolerant to aspirin and/or non-steroidal antiinflamatory drugs (NSAID). The Triflusal versus Aspirin for the Prevention of Infarction: A Randomized Stroke Study (TAPIRSS) study was performed to explore the efficacy and safety of triflusal versus aspirin in the prevention of vascular complications in patients with a previous TIA or ischemic stroke in a Latin American population. In this pilot study differences between triflusal and aspirin in the prevention of vascular complications after TIA or ischemic stroke were not observed. Hemorrhagic risk was lower with triflusal than with aspirin. The TAPIRSS study contributed evidence on the efficacy and safety of triflusal as a valid alternative to aspirin in the prevention of vascular events in patients with ischemic stroke or TIA.

Keywords

antiplatelet agentaspirinstroketransient ischemic attacktriflusal.
Type
Research Article
Information
Progress in Neurotherapeutics and Neuropsychopharmacology , Volume 3 , Issue 1 , January 2008 , pp. 13 - 33
Copyright
© 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Acarin, L., González, B., & Castellano, B. (2002). Decrease of proinflammatory molecules correlates with neuroprotective effect of the fluorinated salicylate triflusal after postnatal excitotoxic damage. Stroke, 33, 2499–2505.Google Scholar
Albers, G.W., Amarenco, P., Easton, J.D., & Sacco, R.L. (2004). Antithrombotic and thrombolytic therapy for ischemic stroke. The seventh ACCP Conference on antithrombotic and thrombolytic therapy. Chest, 126, 483S–512S.Google Scholar
Albors, M., de Castellarnau, C., Vila, L., et al. (1987). Inhibition of thromboxane production and platelet function by triflusal in healthy volunteers. Revista de Farmacología Clínica y Experimental 4, 11–16.Google Scholar
Antiplatelet Trialist's Collaboration (1994). Collaborative overview of randomised trials of antiplatelet therapy. I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. British Medical Journal, 308, 81–106.Google Scholar
Antithrombotic Trialists' Collaboration (2002). Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. British Medical Journal, 324, 71–86.Google Scholar
Aramendi, J.I., Mestres, C.A., Martínez-León, J., et al. (2005). Triflusal versus oral anticoagulation for primary prevention of thromboembolism after bioprosthetic valve replacement (trac): prospective, randomized, co-operative trial. European Journal of Cardio-Thoracic Surgery, 27, 854–860.Google Scholar
Bayón, Y., Alonso, A., & Sánchez Crespo, M. (1999). 4-Trifluoromethyl derivatives of salicylate, triflusal and its main metabolite 2-hydroxy-4-trifluoromethylbenzoic acid, are potent inhibitors of nuclear factor κ B activation. British Journal of Pharmacology, 126, 1359–1366.Google Scholar
CAPRIE Steering Committee (1996). A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet, 1996, 348, 1329–1339.Google Scholar
Costa, J., Ferro, J.M., Matías-Guíu, J., Alvarez-Sabín, J., & Torres, F. (2005). Triflusal for preventing serious vascular events in people at high risk. The Cochrane Database of Systematic Reviews 2005, 3, Art. N.: CD004296.pub2. DOI: 10.1002/14651858.CD004296.pub.2.Google Scholar
Cruz-Fernández, J.M. (2001). Antiplatelet drugs in the treatment of acute coronary syndromes: focus on cyclooxigenase inhibitors. European Heart Journal, 3 (Suppl. I), 123–130.Google Scholar
Cruz-Fernández, J.M., López-Bescós, L., García-Dorado, D., et al. (2000). Randomized comparative trial of triflusal and aspirin following acute myocardial infarction. European Heart Journal, 21, 457–465.Google Scholar
Culebras, A., Rotta-Escalante, R., Domínguez, R., et al. (2004). Triflusal vs aspirin for prevention of cerebral infarction. Neurology, 62, 1073–1080.Google Scholar
Dela Cruz, G., Sorio, F., Pérez, I., et al. (2002). Estudio de seguridad del triflusal, en pacientes asmáticos con intolerancia a aspirina y/o AINES. Revista de medicina de la Universidad de Navarra, 14, 5–46.Google Scholar
De La Cruz, J.P., Pavía, J., García-Arnes, J., et al. (1998). Effects of triflusal and acetylsalicylic acid on platelet aggregation in whole blood of diabetic patients. European Journal of Haematology, 40, 232–236.Google Scholar
De La Cruz, J.P., Pavía, J., Bellido, I., et al. (1995a). Effects of triflusal and its main metabolite HTB on platelet interaction with subendothelium in healthy volunteers. European Journal of Clinical Pharmacology, 47, 497–502.Google Scholar
De La Cruz, J.P., Villalobos, M.A., García, P.J., et al. (1995b). Effects of triflusal and its main metabolite HTB on platelet interaction with subendothelium in healthy volunteers. European Journal of Clinical Pharmacology, 47, 497–502.Google Scholar
Diener, H.C., Cunha, L., Forbes, C., Sivenius, J., Smets, P., & Lowenthal, A. (1996). European stroke prevention study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. Journal of the Neurological Sciences, 143, 1–13.Google Scholar
Domínguez, M.J., Vacas, M., Sáez, Y., et al. (1985). Effects of triflusal in patients with prosthetic valves. Clinical Therapeutics, 7, 357–360.Google Scholar
Edvarson, N., Juul-Moller, S., Omblus, R., & Pehersson, K. (2003). Effect of low dose warfarin and aspirin on stroke versus no treatment on stroke in a medium-risk patient population with atrial fibrillation. Journal of Internal Medicine, 254, 95–101.Google Scholar
Ferrari, E., Reboldi, G., Marenco, P., et al. (1996). Pharmacokinetic study of triflusal in elderly subjects after single and repeated oral administration. American Journal of Therapeutics, 3, 630–636.Google Scholar
García-Rafanell, J., Ramis, J., Gómez, L., et al. (1986). Effect of triflusal and other salicylic acid derivatives on cyclic AMP levels in rat platelets. Archives Internationales de Pharmacodynamie et de Therapie, 284, 155–165.Google Scholar
Goldstein, L.B., Adams, R., Becker, K., et al. (2001). Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke, 32, 280–299.Google Scholar
Guiteras, P., Altimiras, J., Arís, A., et al. (1989). Prevention of aortocoronary vein-graft attrition with low-dose aspirin and triflusal, both associated with dipyridamole: a randomized, double-blind, placebo-controlled trial. European Heart Journal, 10, 159–167.Google Scholar
Gullov, A.L., Koefoed, B.G., Petersen, P., et al. (1998). Fixed minidose warfarin and aspirin alone and in combination vs adjusted-dose warfarin for stroke prevention in atrial fibrillation: second copenhagen atrial fibrillation, aspirin and anticoagulation study. Archives of Internal Medicine, 158, 1513–1521.Google Scholar
Heye, N., Campos, A., Kannuki, S., et al. (1991). Effects of triflusal and acetylsalicylic acid on microthrombi formation in experimental brain ischemia. Experimental Pathology, 41, 31–36.Google Scholar
Ibáñez, L., Vidal, X., Vendrell, L., Moretti, U., & Laporte, J.R. (2006). Upper gastrointestinal bleeding associated with antiplatelet drugs. Alimentary Pharmacology & Therapeutics, 23, 235–242.Google Scholar
Lanas, A., Serrano, P., Bajador, E., Fuentes, J., & Sainz, R. (2003). Risk of upper gastrointestinal bleeding associated with non-aspirin cardiovascular drugs, analgesics and nonsteroidal anti-inflammatory drugs. European Journal of Gastroenterology and Hepatology, 15, 173–178.Google Scholar
Matías-Guíu, J., Ferro, J.M., Alvarez-Sabín, J., et al. (2003). Comparison of triflusal and aspirin for prevention of vascular events in patients after cerebral infarction. The TACIP study: a randomized, double-blind, multicenter trial. Stroke, 34, 840–848.Google Scholar
Matías-Guíu, J., Alvarez-Sabín, J., & Codina, A. (1997). Estudio comparativo del efecto del ácido acetilsalicílico en dosis bajas y el triflusal en la prevención de eventos cardiovasculares en adultos jóvenes con enfermedad cerebrovascular isquémica. Revista de Neurologia, 25, 1669–1672.Google Scholar
Mc Neely, W., & Goa, K.L. (1998). Triflusal. Drugs, 55, 823–833.Google Scholar
Patrono, C., Coller, B., Dalen, J.E., et al. (2001). Platelet-active drugs: the relationship among dose, effectiveness, and side effects. Chest, 119, 39S–63S.Google Scholar
Pérez-Gómez, F., Alegría, E., Berjón, J., et al. for the NASPEAF Investigators (2004). Comparative effects of antiplatelet, anticoagulant, or combined therapy in patients with valvular and nonvalvular atrial fibrillation. Journal of the American College of Cardiology, 44, 1557–1566.Google Scholar
Plaza, L., López-Bescós, L., Martín-Jadraque, L., et al. (1993). Protective effect of triflusal against acute myocardial infarction in patients with instable angina: results of a Spanish multicenter trial. Cardiology, 82, 388–398.Google Scholar
Ramis, J., Mis, R., Forn, J., et al. (1991). Pharmacokinetics of triflusal and its main metabolite HTB in healthy subjects following a single oral dose. European Journal of Drug Metabolism and Pharmacokinetics, 16, 269–273.Google Scholar
Ramis, J., Torrent, J., Mis, R., et al. (1990). Pharmacokinetics of triflusal after single and repeated doses in man. International Journal of Clinical Pharmacology, Therapy, & Toxicology, 28, 344–349.Google Scholar
Sánchez de Miguel, L., Montón, M., Arriero, M.M., et al. (2000). Effect of triflusal on human platelet aggregation and secretion: role of nitric oxide. Revista Espanola DeCardiologia, 53, 205–211.Google Scholar
Smirne, S., Ferini-Strambi, L., Cucinotta, D. (1994). Triflusal and prevention of cerebrovascular attacks: a double-blind clinical study versus ASA. Journal of Neurology, 241 (Suppl. 1), S130.Google Scholar
Stroke Prevention in Atrial Fibrillation III Investigators (1996). Adjusted-dose warfarin versus low-intensity, fixed dose warfarin plus aspirin for high-risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet 1996, 348, 633–638.Google Scholar
Valle, M., Barbanoj, M.J., Donner, A., et al. (2005). Access of HTB, main metabolite of triflusal, to cerebrospinal fluid in healthy volunteers. European Journal of Clinical Pharmacology, 61, 103–111.Google Scholar
White, H.D., Gersh, B.J., & Opie, L.H. (2001). Antithrombotic agents: platelet inhibitors, anticoagulants and fibrinolytics. In: Opie, L.H., & Gersh, B.J. (eds.), Drugs for the Heart (5th ed.) Philadelphia: W.B. Saunders Company, pp. 273–322.
Whitehead, S., Cheng, G., Hachinski, V., & Cechetto, D.F. (2005). Interaction between a rat model of cerebral ischemia and β-amiloid toxicity. II. Effects of triflusal. Stroke, 36, 1782–1789.Google Scholar
Weisman, S.M., & Graham, D.Y. (2002). Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events. Archives of Internal Medicine, 162, 2197–2202.Google Scholar