Comparative effects of mesoglycan and ticlopidine treatment on some coagulative parameters in patients with previous ischemic stroke: results of a randomized controlled trial

Abstract

Background: Elevated plasma concentrations of fibrinogen have been found in patients after stroke. Previous studies have demonstrated that high plasma fibrinogen levels are a risk factor for cerebral and myocardial infarction; thus, there has been increasing interest in drugs that can lower these levels. Mesoglycan is an extractive mucopolysaccharide complex of heparan sulfate and dermatan sulfate, with antithrombotic and profibrinolytic properties. Objective: The aim of this randomized controlled trial was to compare the effects of these drugs on functional and immunologic plasma fibrinogen levels and other coagulative parameters. Methods: Criteria for patient enrollment were previous ischemic stroke in the carotid area, a baseline plasma fibrinogen level ≥350 mg/dL, and age >40 years. Patients were randomized into 2 groups, 1 receiving mesoglycan and 1 receiving ticlopidine. Mesoglycan and ticlopidine were orally administered at dosages of 50 mg BID and 250 mg BID, respectively, for 2 months. Results: After 2 months of treatment, we found slight but statistically significant reductions of both functional ( P = 0.01) and immunologic ( P < 0.05) plasma fibrinogen levels in the group receiving mesoglycan; in the ticlopidine-treated group, these reductions were also significant ( P < 0.01 for both). In both groups, this effect was transient; it disappeared 15 days after the end of treatment. No statistically significant changes in prothrombin time, activated partial thromboplastin time, or prothrombin 1 and 2 fragments were found. No serious side effects were reported. Conclusions: These results suggest that mesoglycan was tolerable and reduced plasma fibrinogen levels without interfering with other coagulative parameters. Additional, larger studies are required to confirm these hypotheses.