SECONDARY STROKE PREVENTION WITH LOW-DOSE ASPIRIN, SUSTAINED-RELEASE DIPYRIDAMOLE ALONE AND IN COMBINATION

Patients who had survived a stroke or transient ischaemic attacks (TIA ) were admitted to a trial of low-dose aspirin (50 mg) alone, sustaine d release dipyridamole (400 mg/day) alone, or a combination of the two agents, and results compared with a placebo over 24 months. This low- dose aspirin regimen produced in pairwise comparisons a significant ri sk reduction of 18% for stroke, 13% for stroke and/or death but no red uction in all cause mortality. The sustained release dipyridamole prod uced a significant risk reduction of 16% for stroke, 15% for stroke an d/or death but no significant reduction of mortality. In combination, aspirin and dipyridamole produced a risk reduction of 37 % in stroke, 24% in stroke and/or death, and no reduction in mortality. Similar fin dings were found in TIA, which was a secondary endpoint. These results are highly significant in comparison with placebo. As expected, there were enhanced reports of alimentary side-effects in the aspirin group s and also enhanced bleeding. Dipyridamole was associated with a sligh t increase in headache, which resolved in most patients if therapy was continued. The conclusions are that 50 mg/day of aspirin alone or 400 mg/day of sustained release dipyridamole alone are equally effective in stroke and TIA prevention. When used in combination the effects wer e additive and were significantly more effective than the single agent s. (C) 1998 Elsevier Science Ltd.