Efficacy of combination antiplatelet therapy and nicardipine for chronic cerebral infarction

Abstract

To prevent recurrence of cerebral infarction (CI), the efficacy of antiplatelet therapy, when used in combination with a calcium antagonist, was examined. The study subjects were 57 chronic CI patients (40 men, 17 women; mean age, 68.5 years) who experienced either CI or its recurrence more than 3 months before the start of the study. They were randomly allocated into one of the following four groups for the 8-week study; group A--ticlopidine hydrochloride 200 mg once daily and nicardipine hydrochloride 20 mg three times daily (TID); group B--ticlopidine hydrochloride 200 mg once daily; group C--aspirin 81 mg once daily and nicardipine hydrochloride 20 mg TID; or group D--aspirin 81 mg once daily. Platelet aggregation was measured before treatment and 4 and 8 weeks after the initiation of each therapy by using adenosine diphosphate (ADP) (2 microM and 0.5 microM) and collagen (2 micrograms/mL), and evaluated in terms of percent maximum platelet aggregation. Results showed significant suppression of 2.0 microM ADP platelet aggregation in groups A, B, and C. At 0.5-microM ADP, only groups A and B showed significant platelet aggregation suppression. All groups showed significant suppression of collagen platelet aggregation. In comparing single therapy with combination therapy, groups A and B were not significantly different from one another after 4 or 8 weeks in 2-microM ADP or collagen platelet aggregation suppression. In contrast, group C had significantly greater suppression of both 2-microM ADP and collagen aggregations compared with group D. In conclusion, nicardipine hydrochloride administration with aspirin may be a useful alternative therapy for the prevention of CI recurrence.