Randomized comparative trial of triflusal and aspirin following acute myocardial infarction

Aims To compare the efficacy and tolerability of the antiplatelet agent tri flusal with aspirin in the prevention of cardiovascular events following ac ute myocardial infarction. Methods and Results In this double-blind, multicentre, sequential design st udy, patients were randomized within 24h of acute myocardial infarction sym ptom onset to receive triflusal 600 mg or aspirin 300 mg once daily for 35 days. The primary end-point was death, non-fatal myocardial reinfarction or a non-fatal cerebrovascular event. The incidences of these individual outc omes and urgent revascularization were secondary end-points. The null hypot hesis of no difference between treatments in the primary combined end-point was accepted with 80% power after recruiting 2124 validated patients (odds ratio (OR) for failure [95% confidence interval (CI)]: 0.882 [0.634-1227]) . Non-fatal cerebrovascular events were significantly less frequent with tr iflusal (OR [95% CI]: 0.364 [0.146-0.908]; P=0.030). There was no significa nt difference between treatments for death (OR [95% CI]: 0.816 [0.563-1.179 ]; P=0.278), non-fatal reinfarction (OR [95% CI]: 1.577 [0.873-2.848]; P=0. 131) or revascularization (OR [95% CI]: 0.864 [0.644-1.161]; P=0.334). Over all, both drugs were well tolerated, although there was a trend towards few er bleeding episodes with triflusal; significantly fewer central nervous sy stem bleeding episodes were observed in triflusal-treated patients (0.27% v s 0.97%; P=0.033). Conclusion Triflusal and aspirin have similar efficacy in preventing furthe r cardiovascular events after acute myocardial infarction, but triflusal sh owed a more favourable safety profile. Triflusal significantly reduced the incidence of non-fatal cerebrovascular events compared with aspirin. (C) 20 00 The European Society of Cardiology.