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(Stroke. 2008;39:1076.)
© 2008 American Heart Association, Inc.

Editorials

The Ideal Antiplatelet Drug for Stroke Prevention—Still Elusive

John W. Norris, MD, FRCP

From Clinical Neuroscience, St Georges Medical School, London, UK.

Correspondence to John W. Norris, MD, FRCP, Clinical Neuroscience, St Georges Medical School, London, UK, SW17 0RE. E-mail carotid@btopenworld.com

Key Words: antiplatelet drugs • antiplatelet Rx • prevention • stroke

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 1358–1363.

Since the publication of the Antiplatelet Trialists Collaboration meta-analyses well over a decade ago¹ showing a relative risk reduction of 25% from aspirin for all secondary vascular ischemic events in patients presenting with a variety of vascular disorders, there have been numerous attempts to improve on these modest benefits. Reducing the dose of aspirin reduced the risks of bleeding while maintaining therapeutic effectiveness,² but using other antiplatelet drugs with different pharmacological actions such as ticlopidine, clopidogrel, or dipyrimadole have so far not produced any impresssive differences from those early data.

The many attempts to pool the results of tens of thousands of patients using meta-analyses from the accumulating data of all these antiplatelet trials have also proven contentious. The problem with any meta-analysis is that the investigator must be selective, so introducing bias, but clearly should not include trials with obvious outdated methodology, incomplete data sets or where the patient cohort is so selective it can be generalized only to a minority of patients.

This issue of Stroke includes a fresh attempt at an extensive meta-analysis of results from trials of the combination of aspirin and dipyrimadole in preventing further vascular events after stroke or transient ischemic attacks (TIAs).³ The authors examined published and unpublished studies, as well as those using immediate and extended-release dipyrimadole formulations. Their analysis was stringent, and only 6 randomized studies out of over 70 met their inclusion criteria for subsequent analysis. They concluded that the combination of aspirin plus . . . [Full Text of this Article]

Related Article:

Aspirin Plus Dipyridamole Versus Aspirin for Prevention of Vascular Events After Stroke or TIA: A Meta-Analysis

Piero Verro, Phillip B. Gorelick, and Danh Nguyen
Stroke 2008 39: 1358-1363. [Abstract] [Full Text] [PDF]