Patients who have a mini-stroke or non-disabling stroke have a yearly risk of new circulatory events including major stroke and heart attack. Doctors know that aspirin can help prevent new circulatory problems but whether the addition of dipyridamole would also be beneficial has been unclear until now.
In the European/Australasian Stroke Prevention in Reversible Ischemia Trial (ESPIRIT), an international study group co-ordinated from the University Medical Center Utrecht, The Netherlands, compared the effect of dipyridamole and aspirin with aspirin alone in patients with minor stroke. 1363 patients were assigned the combination treatment and 1376 aspirin alone. The investigators found that patients on combination therapy had fewer circulatory events (13%) than those on aspirin alone (16%). This corresponds to an absolute risk reduction of 1% per year for circulatory events in the group on combination treatment. Patients on the combination treatment discontinued their treatment more often than those on aspirin, mainly because of headache. When the team combined the data from ESPIRIT with a meta-analysis of previous trials the combination treatment reduced the relative risk of vascular death, stroke, or heart attack by 18%.
Dr Algra states: "The results of ESPIRIT, combined with the results of previous trials, provide sufficient evidence to prefer the combination therapy of aspirin and dipyridamole over aspirin monotherapy after cerebral ischaemia [stroke]."
See also accompanying Comment.
Contact: Dr Ale Algra MD, PhD, Department of Neurology, Rudolf Magnus Institute of Neuroscience, and Julius Center for Health Sciences and Primary Care, Room STR 6.131 , PO Box 85500, University Medical Center Utrecht, 3508 GA Utrecht, Netherlands. T) +31 30 250 9350 A.Algra@umcutrecht.nl or Mrs. A. Aarts, Department of Communication, UMC Utrecht, T) +31 30 250 7483 A.Aarts@umcutrecht.nl
Journal
The Lancet