Dipyridamole plus aspirin prevents recurrent stroke

Dipyridamole plus aspirin is superior to aspirin alone in preventing recurrent vascular events in patients who earlier had suffered eschaemic stroke, according to data presented at the recent 16th European Stroke Conference in Glasgow.

The new analysis of five clinical trials compared 3,800 patients who were treated with dipyridamole plus aspirin with 3,812 other patients who received aspirin alone. Most patients received dipyridamole as an extended-release formulation.

Overall, the combination of dipyridamole and aspirin was significantly more effective than aspirin alone in preventing recurrent stroke, with a relative reduction of 22 percent.

The combined endpoint of vascular death, non-fatal heart attack and non-fatal stroke was significantly reduced by 18 percent.

The combined therapy was also beneficial to patients who were hypertensive or had previous heart disease.

Prof. Ale Algra of the University Medical Center in Utrecht, Netherlands, co-author of the analysis, confirmed that the combination of aspirin and dipyridamaole is more effective than aspirin alone in patients with TIA or ischaemic stroke of presumed arterial origin.

“This means that in the secondary prevention of stroke, stroke patients can benefit from the combination therapy independent of their underlying risk,” Algra said.

The largest trials included in the analysis were the recent European Australasian Stroke Prevention in Riversible ischaemia Trial (ESPRIT) and the second European Stroke Prevention Study.

Both trials reported significant reductions in recurrent strokes treated with dipyridamole plus aspirin, compared with aspirin alone.

The better absorption properties of release formulation of dipyridamole plus aspirin were also discussed by Prof. Hartmut Derendorf of the University of Florida in a symposium at the European Stroke Conference.

He demonstrated that dipyridamole formulation found in the combined therapy is better absorbed than an immediate release dipyridamole formulation.

Stroke is the third cause of death worldwide after heart disease and cancer. Patients who survive a first stroke or TIA are at high risk of suffering a second stroke and require preventive treatment to reduce this risk.

The world’s secondary stroke prevention study — Prevention Regimen For Effectively avoiding Second Strokes (PRoFESS) — aims to demonstrate that extended release dipyridamole plus aspirin is superior in preventing secondary strokes compared with clopidogrel.

The trial has enrolled 20,333 patients in 35 countries. The PRoFESS results are expected at the European Stroke Conference in Nice, France in 2008.