Published Online
on November 29, 2004

A more recent version of this article appeared on January 1, 2005

This Article Full Text (PDF) All Versions of this Article: 36/1/162    most recent 01.STR.0000149621.95215.eav1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Leonardi-Bee, J. Search for Related Content PubMed PubMed Citation Articles by Leonardi-Bee, J. Related Collections Platelet function inhibitors Antiplatelets

Submitted on April 14, 2004
Revised on June 17, 2004
Accepted on September 27, 2004

Dipyridamole for Preventing Recurrent Ischemic Stroke and Other Vascular Events. A Meta-Analysis of Individual Patient Data From Randomized Controlled Trials

Jo Leonardi-Bee MSc; Philip M.W. Bath FRCP^*; Marie-Germaine Bousser MD; Antoni Davalos MD; Hans-Christoph Diener MD; Bernard Guiraud-Chaumeil MD; Juhani Sivenius MD; Frank Yatsu MD; Michael E. Dewey PhD; on behalf of the Dipyridamole in Stroke Collaboration (DISC)

From the University of Nottingham (J.L.-B., P.M.W.B., M.E.D.), Nottingham, UK; the Hopital de la Salpetriere (M.-G.B.), Paris, France; the Hospital Universitari Doctor Josep Trueta (A.D.), Girona, Spain; the University of Essen (H.-C.D.), Essen, Germany; C H U de Toulouse-Purpan (B.G.-C.), Toulouse, France; the University Hospital of Kuopio (J.S.), Kuopio, Finland; the University of Texas (F.Y.), Houston, Tex; and the Institute of Psychiatry (M.E.D.), London, UK.

^* To whom correspondence should be addressed. E-mail: philip.bath{at}nottingham.ac.uk.

Background and Purpose--Results from randomized controlled trials of dipyridamole, given with or without aspirin, for secondary prevention after ischemic stroke or transient ischemic attack (TIA) have given conflicting results. We performed a meta-analysis using individual patient data from relevant randomized controlled trials.

Methods--Randomized controlled trials involving dipyridamole in patients with previous ischemic stroke or TIA were sought from searches of the Cochrane Library, other electronic databases, references lists, earlier reviews, and contact with the manufacturer of dipyridamole. Individual patient data were merged from 5 of 7 relevant trials involving 11 459 patients. Results were adjusted for age, gender, qualifying event, and history of previous hypertension.

Results--Recurrent stroke was reduced by dipyridamole as compared with control (OR, 0.82; 95% CI, 0.68 to 1.00), and by combined aspirin and dipyridamole versus aspirin alone (OR, 0.78; 95% CI, 0.65 to 0.93), dipyridamole alone (OR, 0.74; 95% CI, 0.60 to 0.90), or control (OR, 0.61; 95% CI, 0.51 to 0.71). The point estimates obtained for the comparisons of aspirin and dipyridamole versus control (OR, 0.63; significant) or versus aspirin (OR, 0.88; nonsignificant) were similar if the data from the largest trial, ESPS II (which provided 57% of data), were excluded. Similar findings were observed for nonfatal stroke. The combination of aspirin and dipyridamole also significantly reduced the composite outcome of nonfatal stroke, nonfatal myocardial infarction, and vascular death as compared with aspirin alone (OR, 0.84; 95% CI, 0.72 to 0.97), dipyridamole alone (OR, 0.76; 95% CI, 0.64 to 0.90), or control (OR, 0.66; 95% CI, 0.57 to 0.75). Vascular death was not altered in any group.

Conclusions--Dipyridamole, given alone or with aspirin, reduces stroke recurrence in patients with previous ischemic cerebrovascular disease. The combination of aspirin and dipyridamole also reduces the composite of nonfatal stroke, nonfatal myocardial infarction, and vascular death as compared with aspirin alone.

Key words: aspirin • dipyridamole • stroke prevention • transient ischemic attack

This article has been cited by other articles:

				P H A Halkes, L J Gray, P M W Bath, H-C Diener, B Guiraud-Chaumeil, F M Yatsu, and A Algra Dipyridamole plus aspirin versus aspirin alone in secondary prevention after TIA or stroke: a meta-analysis by risk J. Neurol. Neurosurg. Psychiatry, November 1, 2008; 79(11): 1218 - 1223. [Abstract] [Full Text] [PDF]

				A. Natarajan, A. G Zaman, and S. M Marshall Platelet hyperactivity in type 2 diabetes: role of antiplatelet agents Diabetes and Vascular Disease Research, June 1, 2008; 5(2): 138 - 144. [Abstract] [PDF]

				N. A. Nickman, J. Biskupiak, F. Creekmore, H. Shah, and D. I . Brixner Antiplatelet medication management in patients hospitalized with ischemic stroke Am. J. Health Syst. Pharm., November 1, 2007; 64(21): 2250 - 2256. [Abstract] [Full Text] [PDF]

				J. Montaner Response to Letter by Topakian et al Stroke, October 1, 2006; 37(10): 2455 - 2456. [Full Text] [PDF]

				C. Sudlow What is the role of dipyridamole in long-term secondary prevention after an ischemic stroke or transient ischemic attack? Can. Med. Assoc. J., October 25, 2005; 173(9): 1024 - 1026. [Full Text] [PDF]

				A. Gamboa, R. Abraham, A. Diedrich, C. Shibao, S. Y. Paranjape, G. Farley, and I. Biaggioni Role of Adenosine and Nitric Oxide on the Mechanisms of Action of Dipyridamole Stroke, October 1, 2005; 36(10): 2170 - 2175. [Abstract] [Full Text] [PDF]

				J. W. Norris Antiplatelet Agents in Secondary Prevention of Stroke: A Perspective Stroke, September 1, 2005; 36(9): 2034 - 2036. [Abstract] [Full Text] [PDF]

				G. J Hankey Review: dipyridamole given with or without aspirin reduces recurrent stroke Evid. Based Med., August 1, 2005; 10(4): 113 - 113. [Full Text] [PDF]