Ticlopidine, sold under the brand name Ticlid, is a medication used to reduce the risk of thrombotic strokes. It is an antiplatelet drug in the thienopyridine family which is an adenosine diphosphate (ADP) receptor inhibitor. Research initially showed that it was useful for preventing strokes and coronary stent occlusions. However, because of its rare but serious side effects of neutropenia and thrombotic thrombocytopenic purpura it was primarily used in patients in whom aspirin was not tolerated, or in whom dual antiplatelet therapy was desirable. With the advent of newer and safer antiplatelet drugs such as clopidogrel and ticagrelor, its use remained limited. It was patented in 1973 and approved for medical use in 1978. Medical uses Ticlopidine is indicated for the prevention of strokes and when combined with aspirin, for people with a new coronary stent to prevent closure. Stroke Ticlopidine is considered a second-line option for the prevention of thrombotic strokes among patients who have previously had a stroke or TIA. Studies have shown that it is superior to aspirin in the prevention of death or future strokes. However, it also has more frequent and serious side effects compared to aspirin, so it is reserved for those patients that cannot take aspirin. Heart disease When a patient needs to have a stent placed in one of the vessels around their heart, it is important that that stent stay open to keep blood flowing to the heart. Therefore, patients with stents must take medications after the procedure to help maintain that blood flow. Ticlopidine, taken together with aspirin, is FDA approved for this purpose, and in studies it has been shown to work better than aspirin alone or aspirin with an anticoagulant. However, ticlopidine’s serious side effects make it less useful than its cousin, clopidogrel. Current recommendations no longer recommend ticlopidine’s use. Contraindications The use of ticlopidine is contraindicated in anyone with: Increased risk of bleeding (i.e. frequent falls, gastrointestinal bleeds) History of hematological disease Severe liver disease History of allergic reaction to ticlopidine or any thienopyridine drug such as clopidogrel Because of the increased risk of bleeding, patients taking ticlopidine should discontinue the medication 10–14 days before surgery. Adverse effects The most serious side effects associated with ticlopidine are those that affect the blood cells, although these life-threatening complications are relatively rare. The most common side effects include: Diarrhea Nausea Dyspepsia Rash Abdominal pain Ticlopidine may also cause an