Does ticlopidine treatment lower plasma fibrinogen? A review of the literature

Abstract

Epidemiological studies have demonstrated that plasma fibrinogen (Fg) level in the superior quartils is predictif of an increased risk of cardiovascular thrombotic events. Many clinical studies have evaluated the clinical efficiency of ticlopidine in vascular pathology and in several of them, plasma Fg levels have been determined. We analyzed all reported data to evaluate the effect of ticlopidine on plasma Fg levels. These studies are heterogeneous: plasma Fg concentration was measured using various methods; patients were included at various time after the acute event and were followed over a period of 1 to 24 months of treatment with ticlopidine; patients suffered from peripheral arterial disease and/or cerebrovascular disease and/or diabetes and/or polycythemia vera. Despite the heterogeneity of these prospective studies, a general trend indicates a decrease in the plasma Fg levels by 10 to 25% during the first 3 months of therapy with ticlopidine compared to placebo. This decrease in circulating Fg was, when studied, associated with clinical improvement and hemorheological modifications (decreases in whole blood and plasma viscosities). However, no definitive conclusion can be drawn concerning the effect of ticlopidine on plasma Fg levels and, if this effect exists, does it participate to the clinical benefit of the treatment together with its antithrombotic effect?