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(Stroke. 2008;39:1358.)
© 2008 American Heart Association, Inc.

Comments, Opinions, and Reviews

Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA

A Meta-Analysis

Piero Verro, MD, MS; Phillip B. Gorelick, MD, MPH Danh Nguyen, PhD

From the Department of Neurology and Stroke Program (P.V.) and the Division of Biostatistics, Department of Public Health Sciences (D.N.), University of California, Davis, Sacramento, Calif; and the Center for Stroke Research, Department of Neurology and Rehabilitation (P.B.G.), University of Illinois College of Medicine at Chicago.

Correspondence to Piero Verro, MD, University of California, Davis Medical Center, 2315 Stockton Boulevard, Room 5308, Sacramento, CA 95817. E-mail piero.verro{at}ucdmc.ucdavis.edu

Background and Purpose— This meta-analysis systematically reviewed randomized controlled trials comparing aspirin plus dipyridamole with aspirin alone in patients with stroke and TIA to determine the efficacy of these agents in preventing recurrent cerebral and systemic vascular events.

Methods— We performed separate analyses of the incidences of stroke alone and composite outcome of stroke, myocardial infarction, or vascular death. We also performed two subset analyses, planned a priori, to examine effect size based on trials using (1) exclusively immediate-release and (2) predominantly extended-release dipyridamole.

Results— The summary results indicate a significant reduction in the overall risk ratio in favor of aspirin plus dipyridamole for stroke alone with relative risk 0.77 (0.67 to 0.89) and the composite end point with relative risk 0.85 (0.76 to 0.94). Studies using immediate-release dipyridamole showed a nonstatistically significant trend in favor of the combination for stroke alone with relative risk 0.83 (0.59 to 1.15) and for the composite outcome with relative risk 0.95 (0.75 to 1.19). Studies using predominantly extended-release dipyridamole showed a statistically significant difference in favor of the combination for stroke alone with relative risk 0.76 (0.65 to 0.89) and for the composite outcome with relative risk 0.82 (0.73 to 0.92).

Conclusions— The combination of aspirin plus dipyridamole is more effective than aspirin alone in preventing stroke and other serious vascular events in patients with minor stroke and TIAs. The risk reduction was greater and statistically significant for studies using primarily extended release dipyridamole, which may reflect a true pharmacological effect or lack of statistical power in studies using immediate release dipyridamole.

Key Words: antiplatelet drugs • cerebrovascular accident • prevention • stroke management • transient ischemic attack

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