Critical analysis of the combination of dipyridamole plus acetylsalicylic acid versus acetylsalicylic acid alone in the secondary prevention of stroke

The second European Stroke Prevention Study (ESPS-2) has provided evidence in favour of the administration of acetylsalicyclic acid plus dipyridamole combined (ASA/dipyridamole) versus ASA or dipyridamole alone for the second ary prevention of stroke. Statistical analyses of 14 previous randomized tr ials of different treatment indications and the three randomized trials of the secondary prevention of stroke found no significant difference between ASA/dipyridamole and ASA alone. Inclusion of the ESPS-2 data in the analysi s of the secondary prevention of stroke trials produced a relative risk of vascular events of 0.83 (95% confidence interval [CI] 0.72-0.95) for ASA/di pyridamole versus ASA alone. Data from ESPS-2 indicate that ASA/dipyridamol e therapy prevents 26 strokes and/or deaths per 1000 treated patients compa red with ASA alone, and prevents 56 strokes and/or deaths per 1000 treated patients compared with placebo.